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Review
. 2025;32(1):83-89.
doi: 10.5603/cj.98323. Epub 2025 Jan 8.

Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint

Affiliations
Review

Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint

Jacek Kubica et al. Cardiol J. 2025.

Abstract

According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion.

Keywords: P2Y12 receptor inhibition; antiplatelet therapy; cangrelor; ticagrelor.

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Conflict of interest statement

Conflict of interest: JK — reports fees for lectures and advisory board from AstraZeneca, Boehringer Ingelheim, Ferrer; PA — reports fees from AstraZeneca and Boehringer Ingelheim for lectures; AK — reports fees from AstraZeneca for lectures; MO — reports fees from AstraZeneca and Boehringer Ingelheim for lectures; DAG — reports institutional research grants from Bayer and Bristol Myers Squibb, and has received speaker fees from AstraZeneca, Bayer, and Boehringer Ingelheim. PAG — reports grants and personal fees from Bayer HealthCare LLC, Otitopic Inc., Amgen, Janssen, U.S. WorldMeds LLC, Instrumentation Laboratory, Hemonetics, Medicure Inc., Idorsia Pharmaceuticals, Hikari Dx, and Novartis, has received personal fees from UpToDate, outside the submitted work, has a patent issued (Detection of Restenosis Risk in Patients and Assessment of Cardiac Health and Thrombotic Risk in a Patient), and is an expert witness in litigation involving clopidogrel; MJ — reports speaking fees and travel grants from Boehringer Ingelheim, Bayer, AstraZeneca, Pfizer; Y-HJ — reports honoraria for lectures from Daiichi Sankyo, Sanofi-Aventis, Amgen, Han-mi Pharmaceuticals, and Dae-woong Pharmaceuticals and research grants or support from Yuhan Pharmaceuticals, Han-mi Pharmaceuticals, Sam-jin Pharmaceuticals, Biotronik, and U&I Corporation; ZM — reports research grants from Idorsia; PR — reports lecture fees/honoraria from Amgen, Novo Nordisk, and Novartis outside the submitted work; EPN — reports research grants from Abbott, Amgen, and lecture fees/honoraria from Amgen, AstraZeneca, Bayer, Pfizer, and Sanofi-Regeneron, outside the submitted work; AK-O, TH, RG, PN, MP, PP, UR, JMS-M, GS, ŁS, PS, UT — none.

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