No significant differences in clinical, angiographic or safety outcomes were observed between cangrelor monotherapy and cangrelor combined with intravenous aspirin during mechanical thrombectomy, although these findings should not be interpreted as demonstrating equivalence or excluding a potential benefit of adjunctive aspirin.
Ninety-day favourable functional outcome was similar between cangrelor plus aspirin and cangrelor alone during mechanical thrombectomy.
Secondary efficacy outcomes did not differ between the two strategies.
Safety outcomes, including intracranial haemorrhage and mortality, did not differ significantly between groups.
The study was a retrospective analysis of a multicentre French registry of patients receiving intraoperative cangrelor during thrombectomy.
The authors caution that the results do not demonstrate equivalence or exclude a potential benefit of adjunctive aspirin, and call for prospective studies.
During procedures to remove blood clots from large brain arteries in stroke patients (mechanical thrombectomy), doctors sometimes give blood-platelet-blocking drugs to prevent the vessel from clotting again, for example when the artery is narrowed by underlying disease. Cangrelor is one such drug given through a vein, and some doctors add intravenous aspirin on top of it. This study looked at whether adding aspirin made a difference. Researchers reviewed registry data from 644 patients treated at 34 French stroke centres who received cangrelor during thrombectomy; 226 also received aspirin and 418 did not. After statistical adjustment to make the groups more comparable, about 57% of the combination group and 59% of the cangrelor-alone group had a favourable recovery at 90 days, which was not a significant difference. Rates of reopened arteries, artery openness the next day, brain bleeding (including symptomatic bleeding) and death at 90 days were also not significantly different. This research suggests that adding aspirin to cangrelor did not clearly change outcomes or increase bleeding risk in this group. However, because the study looked back at existing records rather than randomly assigning treatment, and the authors state it does not prove the two approaches are equivalent or rule out a benefit of aspirin, prospective studies are still needed to settle the question.
Milnerowicz M, Cagnazzo F, Desilles J, Kyheng M, Labreuche J, Consoli A, et al.. (2026). Intraoperative cangrelor during mechanical thrombectomy: is the systematic addition of aspirin needed?. European stroke journal. https://doi.org/10.1093/esj/aakag124