Cangrelor

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In cardiology, cangrelor is an purinergic P2Y receptor antagonists that is a platelet aggregation inhibitor.

History

Cangrelor has not been approved for use in the United States by the Food and Drug Administration

Pharmacology

Administration

Distribution

Metabolism

Excretion

Toxicity

Drug toxicity include

Drug interactions

Drug interactions include

Clinical use

Cangrelor has been studied in several major randomized controlled trials:

  • CHAMPION PHOENIX[1]"Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding" according to a randomized controlled trial. [1] In this study of 11,145 patients who were undergoing either urgent or elective percutaneous transluminal coronary angioplasty, the relative risk ratio of cangrelor infusion compared to clopidogrel 600 mg or 300 mg oral bolus for composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization was 0.8 and the relative risk reduction was 20.3%. In populations similar to those in this study which had a rate of risk as measured by the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization of 5.9% without treatment, the number needed to treat is 83. [1]
  • CHAMPION PCI[2] "Cangrelor, when administered intravenously 30 minutes before PCI and continued for 2 hours after PCI, was not superior to an oral loading dose of 600 mg of clopidogrel, administered 30 minutes before PCI, in reducing the composite end point of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours" according to a randomized controlled trial. [2] In this study of 8716 patients undergoing urgent percutaneous transluminal coronary angioplasty, the relative risk ratio of cangrelor infusion compared to 600 mg of clopidogrel prior to PCI for composite of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours was 1.1 and, the relative risk increase was 5.6%. In populations similar to those in this study which had a rate of risk as measured by the composite of death from any cause, myocardial infarction, or ischemia-driven revascularization at 48 hours of 7.1% without treatment, the number needed to harm is 250. [2] All patients who received clopidogrel received the clopidogrel prior to the PCI at the start of the cangrelor infusion.
  • CHAMPION PLATFORM[3] "The use of periprocedural cangrelor during PCI was not superior to placebo in reducing the primary end point" according to a randomized controlled trial. [3] In this study of 5362 patients undergoing urgent percutaneous transluminal coronary angioplasty, the relative risk ratio of cangrelor infusion compared to placebo for composite of death, myocardial infarction, or ischemia-driven revascularization at 48 hours was 0.9 and the relative risk reduction was 12.5%. In populations similar to those in this study which had a rate of risk as measured by the composite of death, myocardial infarction, or ischemia-driven revascularization at 48 hours of 8% without treatment, the number needed to treat is 100.[3] All patients received clopidogrel 600 mg orally after the cangrelor infusion.

External links

The most up-to-date information about Cangrelor and other drugs can be found at the following sites.


References

  1. 1.0 1.1 1.2 Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW et al. (2013). "Effect of platelet inhibition with cangrelor during PCI on ischemic events.". N Engl J Med 368 (14): 1303-13. DOI:10.1056/NEJMoa1300815. PMID 23473369. Research Blogging.
  2. 2.0 2.1 2.2 Harrington RA, Stone GW, McNulty S, White HD, Lincoff AM, Gibson CM et al. (2009). "Platelet inhibition with cangrelor in patients undergoing PCI.". N Engl J Med 361 (24): 2318-29. DOI:10.1056/NEJMoa0908628. PMID 19915221. Research Blogging.
  3. 3.0 3.1 3.2 Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G et al. (2009). "Intravenous platelet blockade with cangrelor during PCI.". N Engl J Med 361 (24): 2330-41. DOI:10.1056/NEJMoa0908629. PMID 19915222. Research Blogging.