Cangrelor for the management and prevention of arterial thrombosis

Abstract

SUMMARYCangrelor is an intravenous, reversibly-binding platelet P2Y 12 receptor antagonist with ultra-rapid onset and offset of action. It is approved in Europe and United States for use in patients undergoing percutaneous coronary intervention, a setting in which it has proven superiority to initial treatment with clopidogrel. Preliminary clinical evidence suggests it would also be a favourable option in bridging patients from discontinuation of oral antiplatelet therapy to the time of major surgery. This review describes the background for the development of cangrelor, the biology, pharmacology and clinical evidence supporting its use, and its likely position in the future.

Comparison of P2Y12 inhibitors for mortality and stent thrombosis in patients with acute coronary syndromes: Single center study of 10 793 consecutive ‘real-world’ patients

“…This may in part be explained by the increased administration of morphine in these patients. There may potentially be a role of intravenous P2Y 12 inhibitors in these patients [35,36].…”

Use of glycoprotein IIb/IIIa antagonists to prevent stent thrombosis in morphine-treated patients with ST-elevation myocardial infarction

“…Cangrelor is a rational option for providing parenteral P2Y 12 inhibition pending the absorption of an oral P2Y 12 inhibitor although a standard 2-hour cangrelor infusion may not be sufficient to cover the period of delayed absorption of the oral inhibitor in all patients and care must be taken if clopidogrel or prasugrel is used as the oral inhibitor since cangrelor can block the binding of clopidogrel and prasugrel active metabolites to the P2Y 12 receptor. 17,18 This observational study is the first to describe the feasibility and outcomes of ÔroutineÕ GPI use in morphine-treated patients undergoing primary PCI. Overall, the adherence to the protocol was fair.…”

Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study)

“…Available parenteral therapies to deal with this issue include glycoprotein IIb/IIIa inhibitors (GPIs) 12 or intravenous P2Y 12 inhibition with cangrelor. 13 However, these options have several limitations. GPIs increase the risk of major bleeding events and routine use has resulted in worse outcomes in several trials.…”

“… 14 15 16 17 Cangrelor has some advantages: It inhibits platelet P2Y 12 receptors within 2 minutes and has rapid offset of action over 1 hour after cessation of infusion. 13 However, it has primarily been used as a 2-hour infusion and this might not be sufficient in patients with more than 2 hours delay in the onset of oral P2Y 12 inhibition. Moreover, the very rapid offset of action may pose a risk should the infusion be interrupted.…”