Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint
- PMID: 39776051
- PMCID: PMC11870009
- DOI: 10.5603/cj.98323
Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint
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.
Conflict of interest statement
Similar articles
-
Platelet Inhibition With Cangrelor and Crushed Ticagrelor in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.Circulation. 2019 Apr 2;139(14):1661-1670. doi: 10.1161/CIRCULATIONAHA.118.038317. Circulation. 2019. PMID: 30630341 Clinical Trial.
-
Randomized Comparison of Oral P2Y12-Receptor Inhibitor Loading Strategies for Transitioning From Cangrelor: The ExcelsiorLOAD2 Trial.JACC Cardiovasc Interv. 2017 Jan 23;10(2):121-129. doi: 10.1016/j.jcin.2016.10.004. JACC Cardiovasc Interv. 2017. PMID: 28104204 Clinical Trial.
-
Periprocedural platelet inhibition with cangrelor in P2Y12-inhibitor naïve patients with acute coronary syndromes - A matched-control pharmacodynamic comparison in real-world patients.Int J Cardiol. 2016 Nov 15;223:848-851. doi: 10.1016/j.ijcard.2016.08.270. Epub 2016 Aug 17. Int J Cardiol. 2016. PMID: 27580219
-
Cangrelor: a novel intravenous antiplatelet agent with a questionable future.Pharmacotherapy. 2014 Oct;34(10):1061-76. doi: 10.1002/phar.1471. Epub 2014 Aug 13. Pharmacotherapy. 2014. PMID: 25123696 Review.
-
Switching from cangrelor to oral P2Y12 inhibitors: a focused review on drug-drug interactions.Expert Opin Drug Metab Toxicol. 2025 Jan;21(1):29-40. doi: 10.1080/17425255.2024.2418033. Epub 2024 Oct 20. Expert Opin Drug Metab Toxicol. 2025. PMID: 39407420 Review.
References
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Research Materials
Miscellaneous