The Utilization of Cangrelor As A Bridge Antiplatelet Therapy in A Patient with Recent History of Percutaneous Coronary Intervention Due to Acute Coronary Syndrome, Who Developed Esophageal Perforation Following Transesophageal Echocardiography

Dual antiplatelet therapy (DAPT) is vital part of the pharmacological management in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). While early discontinuation of DAPT increases ischemic risk, some patients on DAPT may need urgent surgery, necessitating its interruption. Cangrelor, as an intravenous P2Y12 antagonist, provides a strong platelet inhibition within only a few minutes and platelet activity normalizes within one hour after cessation of the drug. The bridging antiplatelet therapy with cangrelor has been increasingly studied as an alternative option to ensure continuation of platelet inhibition in CAD patients requiring discontinuation of DAPT. Present patient with a recent history of PCI for acute coronary syndrome, experienced a significant esophageal perforation following transesophageal echocardiography (TEE). This fatal complication was well-managed with endoscopically and, as part of the recent PCI treatment, prolonged cangrelor infusion was successfully used with no thrombotic or bleeding events throughout the management of the complication.