Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention
Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading doses along with Cyclooxygenase-1 inhibition by aspirin is considered a first-line treatment strategy in patients with the acute coronary syndrome and patients undergoing percutaneous coronary intervention (PCI). Limitations as...
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| Veröffentlicht in: | The American journal of cardiology 2019-04, Vol.123 (7), p.1069-1075 |
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| container_title | The American journal of cardiology |
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| creator | Majmundar, Monil Kansara, Tikal Jain, Akash Shah, Palak Mithawala, Priyam Desai, Rupak Shah, Priyank Doshi, Rajkumar |
| description | Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading doses along with Cyclooxygenase-1 inhibition by aspirin is considered a first-line treatment strategy in patients with the acute coronary syndrome and patients undergoing percutaneous coronary intervention (PCI). Limitations associated with oral P2Y12 receptor inhibitors include a requirement for in vivo conversion (thienopyridines), delayed onset of action, suboptimal inhibition, irreversible inhibition (thienopyridines), and delayed offset. In the acute setting, therapy with potent platelet inhibitors that have a fast onset and offset is desirable to attenuate thrombotic complications. Cangrelor, an intravenous agent, is an adenosine triphosphate analog, selectively and explicitly blocking P2Y12 receptor-mediated platelet activation. Cangrelor has been studied in a series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase III trials (24,910 patients), demonstrated that cangrelor significantly reduced the rate of the composite outcome of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours and 30 days compared with clopidogrel, with no significant increase in major bleeding. It is approved for clinical use in patients undergoing PCI to reduce the risk of myocardial infarction, repeat revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a GPIIbIIIa inhibitor. In conclusion, patients unable to take oral medications undergoing emergent/urgent PCI and those who had recent PCI with drug eluting stent in need for urgent cardiac or noncardiac surgery are potential candidates for cangrelor. |
| doi_str_mv | 10.1016/j.amjcard.2018.12.039 |
| format | Article |
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Limitations associated with oral P2Y12 receptor inhibitors include a requirement for in vivo conversion (thienopyridines), delayed onset of action, suboptimal inhibition, irreversible inhibition (thienopyridines), and delayed offset. In the acute setting, therapy with potent platelet inhibitors that have a fast onset and offset is desirable to attenuate thrombotic complications. Cangrelor, an intravenous agent, is an adenosine triphosphate analog, selectively and explicitly blocking P2Y12 receptor-mediated platelet activation. Cangrelor has been studied in a series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase III trials (24,910 patients), demonstrated that cangrelor significantly reduced the rate of the composite outcome of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours and 30 days compared with clopidogrel, with no significant increase in major bleeding. It is approved for clinical use in patients undergoing PCI to reduce the risk of myocardial infarction, repeat revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a GPIIbIIIa inhibitor. In conclusion, patients unable to take oral medications undergoing emergent/urgent PCI and those who had recent PCI with drug eluting stent in need for urgent cardiac or noncardiac surgery are potential candidates for cangrelor.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2018.12.039</identifier><identifier>PMID: 30654930</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Adenosine Monophosphate - analogs & derivatives ; Adenosine Monophosphate - therapeutic use ; Adenosine triphosphate ; Angina pectoris ; Angioplasty ; Aspirin ; ATP ; Bleeding ; Blood platelets ; Clinical trials ; Clopidogrel ; Complications ; Cyclooxygenase-1 ; Drug delivery ; Drug dosages ; Global Health ; Heart attacks ; Humans ; Implants ; Inhibition ; Inhibitors ; Intervention ; Intravenous administration ; Ischemia ; Meta-analysis ; Myocardial infarction ; Patients ; Percutaneous Coronary Intervention - methods ; Platelets ; Preoperative Care - methods ; Purinergic P2Y Receptor Antagonists - therapeutic use ; Stents ; Surgery ; Surgical implants ; Survival Rate - trends ; Thromboembolism ; Thrombosis</subject><ispartof>The American journal of cardiology, 2019-04, Vol.123 (7), p.1069-1075</ispartof><rights>2019 Elsevier Ltd</rights><rights>Copyright © 2019 Elsevier Ltd. All rights reserved.</rights><rights>2019. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-5bb93355eccb0ce329c39aa86e6bac577e237773a40e1dedd17a85de8bb78c6c3</citedby><cites>FETCH-LOGICAL-c419t-5bb93355eccb0ce329c39aa86e6bac577e237773a40e1dedd17a85de8bb78c6c3</cites><orcidid>0000-0002-5315-6426 ; 0000-0002-5618-2750</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2188915754?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978,64366,64368,64370,72220</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30654930$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Majmundar, Monil</creatorcontrib><creatorcontrib>Kansara, Tikal</creatorcontrib><creatorcontrib>Jain, Akash</creatorcontrib><creatorcontrib>Shah, Palak</creatorcontrib><creatorcontrib>Mithawala, Priyam</creatorcontrib><creatorcontrib>Desai, Rupak</creatorcontrib><creatorcontrib>Shah, Priyank</creatorcontrib><creatorcontrib>Doshi, Rajkumar</creatorcontrib><title>Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading doses along with Cyclooxygenase-1 inhibition by aspirin is considered a first-line treatment strategy in patients with the acute coronary syndrome and patients undergoing percutaneous coronary intervention (PCI). Limitations associated with oral P2Y12 receptor inhibitors include a requirement for in vivo conversion (thienopyridines), delayed onset of action, suboptimal inhibition, irreversible inhibition (thienopyridines), and delayed offset. In the acute setting, therapy with potent platelet inhibitors that have a fast onset and offset is desirable to attenuate thrombotic complications. Cangrelor, an intravenous agent, is an adenosine triphosphate analog, selectively and explicitly blocking P2Y12 receptor-mediated platelet activation. Cangrelor has been studied in a series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase III trials (24,910 patients), demonstrated that cangrelor significantly reduced the rate of the composite outcome of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours and 30 days compared with clopidogrel, with no significant increase in major bleeding. It is approved for clinical use in patients undergoing PCI to reduce the risk of myocardial infarction, repeat revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a GPIIbIIIa inhibitor. In conclusion, patients unable to take oral medications undergoing emergent/urgent PCI and those who had recent PCI with drug eluting stent in need for urgent cardiac or noncardiac surgery are potential candidates for cangrelor.</description><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Adenosine Monophosphate - analogs & derivatives</subject><subject>Adenosine Monophosphate - therapeutic use</subject><subject>Adenosine triphosphate</subject><subject>Angina pectoris</subject><subject>Angioplasty</subject><subject>Aspirin</subject><subject>ATP</subject><subject>Bleeding</subject><subject>Blood platelets</subject><subject>Clinical trials</subject><subject>Clopidogrel</subject><subject>Complications</subject><subject>Cyclooxygenase-1</subject><subject>Drug delivery</subject><subject>Drug dosages</subject><subject>Global Health</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Implants</subject><subject>Inhibition</subject><subject>Inhibitors</subject><subject>Intervention</subject><subject>Intravenous administration</subject><subject>Ischemia</subject><subject>Meta-analysis</subject><subject>Myocardial infarction</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Majmundar, Monil</au><au>Kansara, Tikal</au><au>Jain, Akash</au><au>Shah, Palak</au><au>Mithawala, Priyam</au><au>Desai, Rupak</au><au>Shah, Priyank</au><au>Doshi, Rajkumar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>123</volume><issue>7</issue><spage>1069</spage><epage>1075</epage><pages>1069-1075</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading doses along with Cyclooxygenase-1 inhibition by aspirin is considered a first-line treatment strategy in patients with the acute coronary syndrome and patients undergoing percutaneous coronary intervention (PCI). Limitations associated with oral P2Y12 receptor inhibitors include a requirement for in vivo conversion (thienopyridines), delayed onset of action, suboptimal inhibition, irreversible inhibition (thienopyridines), and delayed offset. In the acute setting, therapy with potent platelet inhibitors that have a fast onset and offset is desirable to attenuate thrombotic complications. Cangrelor, an intravenous agent, is an adenosine triphosphate analog, selectively and explicitly blocking P2Y12 receptor-mediated platelet activation. Cangrelor has been studied in a series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase III trials (24,910 patients), demonstrated that cangrelor significantly reduced the rate of the composite outcome of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours and 30 days compared with clopidogrel, with no significant increase in major bleeding. It is approved for clinical use in patients undergoing PCI to reduce the risk of myocardial infarction, repeat revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a GPIIbIIIa inhibitor. In conclusion, patients unable to take oral medications undergoing emergent/urgent PCI and those who had recent PCI with drug eluting stent in need for urgent cardiac or noncardiac surgery are potential candidates for cangrelor.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30654930</pmid><doi>10.1016/j.amjcard.2018.12.039</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5315-6426</orcidid><orcidid>https://orcid.org/0000-0002-5618-2750</orcidid></addata></record> |
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| subjects | Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Acute coronary syndromes Adenosine Monophosphate - analogs & derivatives Adenosine Monophosphate - therapeutic use Adenosine triphosphate Angina pectoris Angioplasty Aspirin ATP Bleeding Blood platelets Clinical trials Clopidogrel Complications Cyclooxygenase-1 Drug delivery Drug dosages Global Health Heart attacks Humans Implants Inhibition Inhibitors Intervention Intravenous administration Ischemia Meta-analysis Myocardial infarction Patients Percutaneous Coronary Intervention - methods Platelets Preoperative Care - methods Purinergic P2Y Receptor Antagonists - therapeutic use Stents Surgery Surgical implants Survival Rate - trends Thromboembolism Thrombosis |
| title | Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention |
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