Cangrelor: An emerging therapeutic option for patients with coronary artery disease

Jacek Kubica, Marek Kozinski, Eliano Pio Navarese, Udaya Tantry, Aldona Kubica, Jolanta Maria Siller-Matula, Young Hoon Jeong, Tomasz Fabiszak, Anna Andruszkiewicz, Paul Alfred Gurbel

Research output: Contribution to journalArticle

Abstract

Objectives: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. Methods: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. Results: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. Conclusions: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.

Original languageEnglish (US)
Pages (from-to)813-828
Number of pages16
JournalCurrent Medical Research and Opinion
Volume30
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Coronary Artery Disease
clopidogrel
Therapeutics
Percutaneous Coronary Intervention
cangrelor
Safety
Antidotes
Platelet Aggregation Inhibitors
Drug Combinations
Acute Coronary Syndrome
PubMed
Stents
Pharmacokinetics
Myocardial Infarction
Research Personnel
Databases
Survival

Keywords

  • Antiplatelet therapy
  • AR-C69931MX
  • Cangrelor
  • P2Y12 inhibitor

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kubica, J., Kozinski, M., Navarese, E. P., Tantry, U., Kubica, A., Siller-Matula, J. M., ... Gurbel, P. A. (2014). Cangrelor: An emerging therapeutic option for patients with coronary artery disease. Current Medical Research and Opinion, 30(5), 813-828. https://doi.org/10.1185/03007995.2014.880050

Cangrelor : An emerging therapeutic option for patients with coronary artery disease. / Kubica, Jacek; Kozinski, Marek; Navarese, Eliano Pio; Tantry, Udaya; Kubica, Aldona; Siller-Matula, Jolanta Maria; Jeong, Young Hoon; Fabiszak, Tomasz; Andruszkiewicz, Anna; Gurbel, Paul Alfred.

In: Current Medical Research and Opinion, Vol. 30, No. 5, 2014, p. 813-828.

Research output: Contribution to journalArticle

Kubica, J, Kozinski, M, Navarese, EP, Tantry, U, Kubica, A, Siller-Matula, JM, Jeong, YH, Fabiszak, T, Andruszkiewicz, A & Gurbel, PA 2014, 'Cangrelor: An emerging therapeutic option for patients with coronary artery disease', Current Medical Research and Opinion, vol. 30, no. 5, pp. 813-828. https://doi.org/10.1185/03007995.2014.880050
Kubica, Jacek ; Kozinski, Marek ; Navarese, Eliano Pio ; Tantry, Udaya ; Kubica, Aldona ; Siller-Matula, Jolanta Maria ; Jeong, Young Hoon ; Fabiszak, Tomasz ; Andruszkiewicz, Anna ; Gurbel, Paul Alfred. / Cangrelor : An emerging therapeutic option for patients with coronary artery disease. In: Current Medical Research and Opinion. 2014 ; Vol. 30, No. 5. pp. 813-828.
@article{4798172372e34ce4bc9c751981ae02be,
title = "Cangrelor: An emerging therapeutic option for patients with coronary artery disease",
abstract = "Objectives: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. Methods: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. Results: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. Conclusions: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.",
keywords = "Antiplatelet therapy, AR-C69931MX, Cangrelor, P2Y12 inhibitor",
author = "Jacek Kubica and Marek Kozinski and Navarese, {Eliano Pio} and Udaya Tantry and Aldona Kubica and Siller-Matula, {Jolanta Maria} and Jeong, {Young Hoon} and Tomasz Fabiszak and Anna Andruszkiewicz and Gurbel, {Paul Alfred}",
year = "2014",
doi = "10.1185/03007995.2014.880050",
language = "English (US)",
volume = "30",
pages = "813--828",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Informa Healthcare",
number = "5",

}

TY - JOUR

T1 - Cangrelor

T2 - An emerging therapeutic option for patients with coronary artery disease

AU - Kubica, Jacek

AU - Kozinski, Marek

AU - Navarese, Eliano Pio

AU - Tantry, Udaya

AU - Kubica, Aldona

AU - Siller-Matula, Jolanta Maria

AU - Jeong, Young Hoon

AU - Fabiszak, Tomasz

AU - Andruszkiewicz, Anna

AU - Gurbel, Paul Alfred

PY - 2014

Y1 - 2014

N2 - Objectives: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. Methods: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. Results: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. Conclusions: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.

AB - Objectives: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. Methods: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. Results: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. Conclusions: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.

KW - Antiplatelet therapy

KW - AR-C69931MX

KW - Cangrelor

KW - P2Y12 inhibitor

UR - http://www.scopus.com/inward/record.url?scp=84899092192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899092192&partnerID=8YFLogxK

U2 - 10.1185/03007995.2014.880050

DO - 10.1185/03007995.2014.880050

M3 - Article

C2 - 24393016

AN - SCOPUS:84899092192

VL - 30

SP - 813

EP - 828

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 5

ER -