What are your opinions on cangrelor drip for pts that you're admitting for acute coronary syndrome that you feel will have a moderate-to-high probability for meeting indications for CABG? For ACS, I'm mostly referring to NSTEMI (since that's the vast majority if what I see as an IM resident) but feel free to generalize.
I've only been in a small handful of situations when I've had pts with significant cardiac disease presenting with NSTEMI that I've loaded (usually with Plavix), and during the cath they had some combination of disease that led to a CT surgery consult for CABG which ended up being delayed a few days due to the P2Y12 load. Fortunately no harm was done for the pts I've loaded, and we used the few extra days to optimize the pt further prior to surgery (if needed). Although I've had many coresidents yelled at by cardiologists or CT surgeons for doing this.
The option of using a cangrelor drip has been brought up many times. A fast-onset P2Y12 inhibitor that can be turned off ~30 mins prior to surgery, so it seems ideal. I've never been in a situation where I needed to order it, and have only had 2 pts that were already on it before I took over.
How often do you guys use this yourselves or see it being used? I'm surprised it's not used more, maybe due to cost?
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