Predictors of Hemorrhagic Transformation After IV Continuous Cangrelor Infusion Initiated During Mechanical Thrombectomy

BACKGROUND:
Cangrelor, a fast-acting intravenous P2Y12 receptor inhibitor, is increasingly used during mechanical thrombectomy for acute ischemic stroke to treat or prevent thrombotic complications. While effective, its use may increase the risk of hemorrhagic transformation (HT). We investigated clinical, imaging, and procedural predictors of HT in this specific patient population.

METHODS:
We performed a retrospective post hoc single-center study including 101 patients with acute ischemic stroke treated with intravenous cangrelor initiated directly after mechanical thrombectomy and continued for 12 hours between January 2021 and June 2024. Univariate and multivariable logistic regression models were used to assess associations between HT and clinical, radiological, and procedural factors.

RESULTS:

Among the 101 patients included, 25 (24.7%) developed HT, and 9 (8.9%) experienced symptomatic intracerebral hemorrhage. In multivariable analysis, baseline blood glucose (adjusted odds ratio, 6.51 [95% CI, 1.35–31.4];P=0.02), leukocytosis (adjusted odds ratio, 1.18 [95% CI, 1.00–1.38];P =0.047), and subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography (adjusted odds ratio, 16.60 [95% CI, 2.97–92.8];P=0.0014) were independent predictors of HT. Contrast enhancement was associated with HT in univariate analysis but did not remain significant after adjustment.
CONCLUSIONS:
Baseline blood glucose, leukocytosis, and isolated subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography emerged as independent predictors of HT. Identifying high-risk patients using readily available clinical and imaging markers may support individualized antiplatelet strategies and help reduce hemorrhagic complications during cangrelor treatment.