A Safety Evaluation of Cangrelor in Patients Undergoing PCI

ABSTRACT

Introduction: Dual antiplatelet therapy with aspirin and an oral ADP P2Y₁₂ receptor antagonist is the standard-of-care for treatment of patients undergoing percutaneous coronary intervention (PCI). However, oral P2Y₁₂ receptor antagonists have several limitations, including inter- and intra-individual response variability, drug-drug interactions, slow onset and offset of action and delayed platelet inhibition in high-risk clinical settings, such as patients with ST-segment elevation myocardial infarction.

Areas covered: Cangrelor is an intravenous, direct-acting, reversible, potent P2Y₁₂ receptor antagonist. It rapidly achieves near complete platelet inhibition and has a very short half-life and a fast offset of action. We conducted a systematic review searching PubMed/MEDLINE for pharmacodynamic/pharmacokinetic studies and clinical trials in which cangrelor was investigated, published from any time up to November 1^st 2015. For clinical trials, those investigating cangrelor in the setting of PCI were considered for discussion.

Expert opinion: Cangrelor is approved by drug regulating authorities worldwide as adjunctive antithrombotic therapy for the full spectrum of patients undergoing PCI, not pre-treated with a P2Y₁₂ receptor inhibitor and not with intent to receive a glycoprotein IIb/IIIa inhibitor. Its unique pharmacological properties and its favorable safety and efficacy profile make it an attractive treatment strategy, especially in clinical settings where immediate platelet inhibition is required.

KEYWORDS:

• Acute coronary syndrome
• percutaneous coronary intervention
• antiplatelet therapy
• cangrelor
• P2Y₁₂ receptor antagonist

Disclosures

DJ Angiolillo received payment as an individual for: a) Consulting fee or honorarium from Sanofi, Eli Lilly, Daiichi-Sankyo, The Medicines Company, AstraZeneca, Merck, Abbott Vascular and PLx Pharma; b) Participation in review activities from CeloNova, and Johnson & Johnson, St. Jude. Institutional payments for grants from Glaxo Smith Kline, Eli Lilly, Daiichi-Sankyo, The Medicines Company, AstraZeneca, Janssen Pharmaceuticals, Inc., Osprey Medical, Inc., Novartis, CSL Behring, and Gilead. 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.