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Cangrelor: An emerging therapeutic option for patients with coronary artery disease.
MedLine Citation:
PMID:  24393016     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objectives: To perform a systematic up-to-date review and critical discussion on 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, cangrelor-clopidogrel combination is relatively safe and more effective than standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) setting, 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 favourable 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 favouring 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 favourable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.
Authors:
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
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-6
Journal Detail:
Title:  Current medical research and opinion     Volume:  -     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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