Abstract 456: Utilizing Cangrelor, a potent antiplatelet medication, within the scope of External ventricular drainage devices

This comprehensive exploration discusses the rationale behind using Cangrelor as a fast‐acting, reversible platelet inhibiton as it benefits from thwarting thrombotic difficulties during EVD installation and upkeep. These reports propose potential benefits of using Cangrelor in EVDs. Our first case is a 33‐year‐old Caucasian female who presented with a stable Subarachnoid Hemorrhage and Intraventricular Hemorrhage with a 2‐mm right medial Para clinoid internal carotid artery aneurysm (right P COMM), occlusion of the left vertebral artery, and severe narrowing of the distal right vertebral artery. The SAH protocol was implemented, which included administering Nimodipine for 21 days, controlling the patient's blood pressure, providing seizure prophylaxis with Keppra, and placing a right anterior EVD for cerebrospinal fluid diversion. On Day 19, a repeat CT head showed no ventriculomegaly, and the Cangrelor infusion was stopped prior to EVD removal due to safety concerns related to the potential for bleeding during the removal process. Our second case is a A 77‐year‐old male who came into the emergency department due to right‐sided facial drooping and weakness in his right arm and leg. A head CTA revealed a blockage in the left internal carotid artery, a 5mm aneurysm in the anterior cerebral artery, and a stable acute hematoma with extension into the ventricles in the left basal ganglia and corona radiata. An EVD was inserted, and the patient was started on the antiplatelet medication Cangrelor during angioplasty. On the ninth day, the EVD was removed. Intravenous Cangrelor was discontinued, and the patient started taking Plavix and aspirin through a feeding tube. Through these case reports we can see that by cutting down the chances of thrombotic complications, Cangrelor could enhance patient outcomes and lessen the requirement for additional interventions, with its potential to prevent thrombotic complications associated with EVD placement and maintenance, presents an optimistic prospect.