Comparative Efficacy and Safety of Intravenous Cangrelor versus Intravenous Glycoprotein IIb/IIIa Inhibitors after Mechanical Thrombectomy for Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

BACKGROUND: Intravenous cangrelor and Glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa I) are current options in antiplatelet therapy during neurointerventional procedures, potentially enhancing reperfusion and preventing reocclusion. In specific conditions, these antiplatelet agents are employed as adjuvant to mechanical thrombectomy (MT), a procedure that is crucial for patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, direct comparisons of these drugs in this context remain limited.

PURPOSE: To compare the efficacy and safety of cangrelor and GP IIb/IIIa I following MT for AIS.

DATA SOURCES: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies involving AIS patients undergoing MT with intravenous cangrelor or GP IIb/IIIa I.

STUDY SELECTION: The initial search yielded 73 studies from PubMed, 549 studies from Embase, 21 studies from Cochrane, 121 studies from Web of Science, and 342 studies from Scopus, with 1,106 studies in total. After the removal of 536 duplicates, 570 articles underwent initial screening, from which 542 were excluded based on the information provided in the abstract and title, leaving 28 articles for full-text assessment for eligibility. Ultimately, five cohort observational studies were included.

DATA ANALYSIS: All statistical analyses were performed using R (version 4.4.0, R Foundation for Statistical Computing, Vienna, Austria). Efficacy outcomes included successful reperfusion and favorable functional outcomes, while safety outcomes assessed symptomatic intracerebral hemorrhage (sICH), hemorrhagic transformation, and all-cause mortality. Risk ratios (RR) with 95% confidence intervals were calculated, with significance set at P < .05.

RESULTS: Five retrospective cohort studies comprising 630 patients were included, with 191 participants in the cangrelor group (30.32%). There was no significant difference in favorable functional outcomes (RR 1.10; 0.71–1.68; P > .05; I² = 76%). However, cangrelor was associated with better successful reperfusion (RR 1.07; 1.01–1.13; P < .05; I² = 60%). All-cause mortality (RR 1.33; 0.82–2.15; P > .05; I² = 0%), sICH (RR 0.63; 0.33–1.23; P > .05; I² = 23%) and hemorrhagic transformation (RR 0.80; 0.50–1.27; P > .05; I² = 64%) were not significantly different between the groups.

CONCLUSIONS: Cangrelor shows comparable efficacy to GP IIb/IIIa I in functional outcomes, with improved reperfusion, suggesting it as a viable alternative during MT procedures. Further randomized controlled trials are needed for comprehensive evaluation.