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.

Cardiocenter 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady Prague Czech Republic

CAU Thrombosis and Biomarker Center Heart and Brain Hospital Chung Ang University Gwangmyeong Hospital Gwangmyeong Korea

Centre for Health Services Research School of Life and Medical Sciences University of Hertfordshire Hatfield Hertfordshire United Kingdom

Chair of the Cardiology Clinic Ward and Acute Cardiac Care Unit L Rydygier Provincial Integrated Hospital Torun Poland

Departement of Cardiology Baku Medical Plaza Hospitals Azerbaijan

Department of Cardiac Rehabilitation and Health Promotion Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland

Department of Cardiology and Internal Medicine Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland

Department of Cardiology Interventional Cardiology and Electrophysiology with Cardiac Intensive Care Unit Tertiary Care Hospital in Grudziadz Poland

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

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