Meta-Analysis of the Role of Cangrelor for Patients Undergoing Percutaneous Coronary Intervention

• Published in: The American journal of cardiology 2019-04, Vol.123 (7), p.1069-1075
• Main Authors: Majmundar, Monil, Kansara, Tikal, Jain, Akash, Shah, Palak, Mithawala, Priyam, Desai, Rupak, Shah, Priyank, Doshi, Rajkumar
• Format: Article
• Language: English
• 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
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.12.039

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.