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Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ferrer, Barcelona, Spain Background Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable. Purpose To assess the economic implications of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Belgium. Methods A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor in the formulary for the total PCI population (base case) in Belgium were compared. Also, the primary PCI (STEMI) and a PCI population with special needs (e.g., unable to swallow) were assessed as complementary setups. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on Belgian registries. Only the pharmacological costs of pre-treatment (preload) with oral P2Y12 inhibitors and glycoprotein IIb-IIIa inhibitors (GPI) for bail-out were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results. Results The model assumes that the primary PCI population grows from 4,790 to 4,935 adults (age 68 years, mean) over three years in Belgium. Pre-treatment with oral P2Y12 inhibitors increases from 3,544 to 3,652 patients, and uptake of cangrelor rises from 20.60% to 38.30% in the same period. The number of primary PCI patients receiving cangrelor grows from 730 to 1,399. At current usage of antithrombotics and at existing pharmacological and management costs, adding cangrelor into the hospital formulary represents 1.1 million euros over 3 years in Belgium. 6 additional stent thromboses, 3 ischaemia-driven revascularisations and 2 cardiovascular related deaths are avoided while three extra minor bleedings occur over 3 years. Similar pharmacoeconomic findings emerge in the base case and complementary setups. Results are most sensible to the percentage of patients on GPI bail-out. Conclusions Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing primary PCI represents a safe and affordable option in Belgium, particularly when the required control of thrombosis is not certain with oral pre-treatment.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ferrer Background Hypertension/hypotension in the perioperative setting may result in a high economic burden for healthcare systems and patients affected in terms of clinical outcomes. Although previous systematic reviews have shown IV antihypertensive treatments to be highly effective, there is currently a clear gap in the literature regarding a review on the implications of acute hypotensive/hypertensive episodes. Purpose Our goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting. Methods We conducted a systematic peer-review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values. Quality of the studies was graded with the Scottish Intercollegiate Guidelines Network. Results A total of 4,197 articles were identified and 47 articles satisfied criteria for data extraction. We present evidence on outcomes associated with acute hypertension/hypotension distinguishing cardiac from non-cardiac surgeries. For the perioperative setting, the number of articles varies by outcome: 17 mortality, 11 renal outcomes, 3 stroke, 6 delirium, and 21 others. Hypotension was reported to be associated with mortality (OR 1.02-20.826) as well as changes from blood pressure patient’s baseline (OR 1.02-1.36); hypotension had also a role in the development of acute kidney injury (OR 1.03-14.11). Postsurgical delirium was found in relation with lability (OR 1.018-1.038) and intra- and postsurgical hypotension (OR 1.05-1.22), and hypertension (OR 1.44-2.34). However, no statistically significant result was found for the relation between hypotension and stroke, and no study investigating hypertension influence over stroke was found. There was a wide range of additional diverse outcomes related to hypo-, hypertension and blood pressure liability, for example myocardial damage related to a 50% decrease in systolic blood pressure (SBP) (OR 4.4), increased odds 9.6 for new onset of atrial fibrillation associated with intraoperative SBP below 80 mmHg for 15 min or more; myocardial injury, length of stay in hospital, hematoma, or anastomotic leakage were also found to be related to hypertension. Conclusions The perioperative management of blood pressure influences short- and long-term effects of surgical procedures. These findings support the burden of blood pressure fluctuations in this setting. It sounds pertinent to further investigate the role of newer antihypertensive agents with favourable pharmacodynamic and pharmacokinetic properties to guarantee the fine-tuning of blood pressure and an individualised therapy for patients.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ferrer, Barcelona, Spain Background Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable. Purpose To assess the economic implications of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Portugal. Methods A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor in the formulary for the total PCI population (base case) in Portugal were compared. Also, the primary PCI (STEMI) and a PCI population with special needs (ie. unable to swallow) were assessed as complementary setups. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on Portuguese registries. Only the costs of pre-treatment with oral P2Y12 inhibitors and glycoprotein IIb-IIIa inhibitors (GPI) for bail-out were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results. Results The model assumes that the total PCI population grows from 13,422 to 14,370 adults (age 65 years, mean) over three years in Portugal. Pre-treatment with oral P2Y12 inhibitors increases from 9,932 to 10,634 patients, and uptake of cangrelor rises from 0.80% to 1.40% in the same period. The number of total PCI patients receiving cangrelor grows from 79 to 149. At current usage of antithrombotics and at existing pharmacological and management costs, adding cangrelor into the hospital formulary represents 115 thousand € over 3 years in Portugal. Results are most sensible to the percentage of patients on GPI bail-out. Conclusions Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing PCI represents a safe and affordable option in Portugal, particularly when the required control of thrombosis is not certain with oral pre-treatment.