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Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint
J. Kubica, P. Adamski, R. Gajda, A. Kubica, M. Ostrowska, G. Casu, DA. Gorog, PA. Gurbel, T. Hajdukiewicz, M. Jaguszewski, YH. Jeong, A. Kosobucka-Ozdoba, Z. Motovska, P. Niezgoda, M. Piasecki, P. Podhajski, P. Raggi, U. Rahimov, JM....
Language English Country Poland
Document type Journal Article, Review
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PubMed
39776051
DOI
10.5603/cj.98323
Knihovny.cz E-resources
- MeSH
- Adenosine Monophosphate * analogs & derivatives therapeutic use administration & dosage adverse effects MeSH
- Acute Coronary Syndrome * therapy drug therapy diagnosis MeSH
- Purinergic P2Y Receptor Antagonists * administration & dosage adverse effects therapeutic use MeSH
- Platelet Aggregation Inhibitors * therapeutic use administration & dosage adverse effects MeSH
- Percutaneous Coronary Intervention * adverse effects MeSH
- Drug Interactions MeSH
- Humans MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
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.
Departement of Cardiology Baku Medical Plaza Hospitals Azerbaijan
Department of Cardiology Medical University of Gdansk Gdańsk Poland
Department of Cardiology Medical University of Vienna Austria
Department of Cardiology Provincial Hospital Elblag Poland
Department of Clinical and Interventional Cardiology Sassari University Hospital Sassari Italy
Department of Experimental and Clinical Pharmacology Medical University of Warsaw Poland
Department of Internal Medicine Chung Ang University College of Medicine Seoul Korea
Division of Cardiology and Department of Medicine University of Alberta Edmonton Canada
Faculty of Medicine National Heart and Lung Institute Imperial College London United Kingdom
Gajda Med District Hospital in Pultusk Poland
Henry JN Taub Department of Emergency Medicine Baylor College of Medicine Houston Houston TX USA
Institute of Outcomes Research Maria Sklodowska Curie Medical Academy Warsaw Poland
Sinai Center for Thrombosis Research Sinai Hospital of Baltimore Baltimore MD USA
Sinai Center for Thrombosis Research Sinai Hospital of Baltimore USA
References provided by Crossref.org
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- $a Maintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint / $c J. Kubica, P. Adamski, R. Gajda, A. Kubica, M. Ostrowska, G. Casu, DA. Gorog, PA. Gurbel, T. Hajdukiewicz, M. Jaguszewski, YH. Jeong, A. Kosobucka-Ozdoba, Z. Motovska, P. Niezgoda, M. Piasecki, P. Podhajski, P. Raggi, U. Rahimov, JM. Siller-Matula, G. Skonieczny, Ł. Szarpak, P. Szymański, U. Tantry, EP. Navarese
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- $a 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.
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