What it is
When a heart attack is complicated by cardiogenic shock (the heart failing to pump enough blood), patients cannot reliably swallow or absorb the oral antiplatelet drugs that prevent clots during treatment. This trial tested whether an intravenous drug, cangrelor, could match crushed oral ticagrelor. At 29 hospitals across five European countries, 605 patients in shock were randomly assigned to one drug or the other, under blinding of patients, clinicians, and assessors. Cangrelor won clearly on the laboratory measure: among patients tested, effective platelet suppression at the end of the artery-opening procedure was reached in 100% on cangrelor versus 22% on ticagrelor. But on the main clinical endpoint, death, heart attack, or ischaemic stroke at 30 days, cangrelor was not shown to be non-inferior: the events occurred in 38% of the cangrelor group and 41% of the ticagrelor group, a difference whose confidence interval left the question open. Major bleeding was similar (6% versus 5%).
Why it matters
Heart attack with cardiogenic shock is among the deadliest cardiac emergencies, and this is the first randomised trial of antiplatelet strategy in these patients. Oral antiplatelet drugs are standard after a heart attack, but shock undermines them exactly when clotting risk is highest, and practice has had no trial evidence to guide the choice. The result is nuanced: intravenous cangrelor achieves faster, more reliable platelet suppression, yet that laboratory advantage did not translate into a demonstrated clinical benefit, so it does not by itself justify switching. The authors frame the trial as a basis for designing future studies in this setting.
Underlined numbers link to their source. Every metric and quoted figure is listed under Sources and data below.
Filed underAntiplatelet Therapy and Cardiovascular Diseases, Acute Myocardial Infarction Research, Platelet Disorders and Treatments
