Bridging Antiplatelet Therapy With Cangrelor in Spinal Cord Stimulator Trial and Implant for Patient With Refractory Angina: A Case Report.

Background: Antiplatelet medications increase the risk of neuraxial bleeding during spinal cord stimulator (SCS) trials and implants, necessitating adequate discontinuation. However, interrupting antiplatelet therapy is undesirable in patients at high risk for thromboembolism. Cangrelor, a novel nonthienopyridine adenosine triphosphate analog, has a rapid onset and offset that can be used to bridge antiplatelet therapy prior to procedures involving neuraxial access, minimizing the risk of subtherapeutic anticoagulation.

Case report: We present the case of a 44-year-old man with an extensive cardiac history who underwent neuromodulation for refractory angina. The patient was transitioned from prasugrel to cangrelor, with cangrelor being discontinued 3 hours prior to the tunneled SCS trial and subsequent implant. He showed no signs of any complications, including neurological issues, related to bleeding.

Conclusions: This case illustrates the successful use of cangrelor as an antiplatelet bridge prior to a neuraxial procedure.