Adult patients treated in VA ECMO/Impella for cardiogenic shock/cardiac arrest undergoing PCI. Given the high incidence of bleeding from conventional antithrombotic therapy, the use of readily available and rapidly metabolized cangrelor should result in adequate efficacy and increased safety. Patients will receive scoagulation with bivalirudin (target apt 55-70 seconds) and cangrelor with starting dose 0.125 mcg/kg/min and adjusted with step +/- 0.125 mcg/kg/min.

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