Cangrelor for the treatment of patients with Arterial Thrombosis

ABSTRACT

Introduction: All oral P2Y₁₂ receptor blockers are associated with some degree of delayed onset and offset of pharmacodynamic (PD) effects in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Although intravenous glycoprotein IIb/IIIa inhibitors are associated with rapid onset of action, they are also associated with delayed offset and other limitations such as elevated bleeding risk and thrombocytopenia.

Areas covered: In this review, the authors focus on cangrelor, an intravenous, reversible P2Y₁₂ receptor blocker with fast onset and offset of effects. The authors also describe the pharmacologic effects of cangrelor and its pharmacologic interaction with other P2Y₁₂ receptor inhibitors. Finally, the authors discuss the large-scale clinical trials that compared the efficacy and safety of cangrelor with clopidogrel.

Expert opinion: In ACS patients undergoing PCI, cangrelor is most desirable to effectively prevent periprocedural ischemic events and to avoid excessive bleeding. Indeed, any high-risk patient with ST-segment elevation myocardial infraction or patient who is unable to take oral medications is a potential candidate for intravenous cangrelor therapy. Furthermore, stable patients with coronary artery disease, who are considered for ad hoc PCI following coronary angiography, may be considered for treatment with cangrelor to reduce post-PCI thrombotic events.

KEYWORDS:

• Cangrelor
• acute coronary syndrome
• percutaneous intervention
• platelets
• P2Y₁₂ receptor

Declaration of interest

P Gurbel reports receiving grants from the National Institutes of Health, Bayer Healthcare, Medicure, Instrumentation Labs, US WorldMedicals, Haemonetics, Amgen Inc, Idorsia, Ionis, Janssen Pharmaceuticals and Merck & Co. He has received honoraria and payment for lecturing, consultancy and for serving on the speaker’s bureaus of Bayer Healthcare, Janssen Pharmaceuticals, Merck & Co, UptoDate and Medicure. He also holds patents in the area of personalized antiplatelet therapy and interventional cardiology. U Tantry meanwhile reports receiving honoraria from Medicure, AstraZeneca and UptoDate. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was funded by the Inova Heart & Vascular Institute, Falls Church, VA, USA.