title: Pharmacodynamic Effects When Clopidogrel is Given Before Cangrelor Discontinuation.
abstract: OBJECTIVE
  To determine whether initiation of clopidogrel before discontinuation of cangrelor would impact on the recovery of platelet reactivity.
  
  
  BACKGROUND
  The active metabolite of clopidogrel cannot bind to P2Y12 when cangrelor occupies the receptor. Pharmacodynamic studies have shown that this interaction is avoided when clopidogrel is given at the end of the cangrelor infusion. We found that antiplatelet effects of another thienopyridine, prasugrel, were apparent when prasugrel was administered 0.5 hour before cangrelor was stopped.
  
  
  METHODS
  Platelet function studies (light transmission aggregometry, VerifyNow, and flow cytometry) were performed on blood from patients with stable coronary artery disease who were taking aspirin when a loading dose of clopidogrel (600 mg) was given during a cangrelor infusion (0.5 and 1 hour before cangrelor was stopped). Results were compared with those obtained when clopidogrel was given immediately after cangrelor was stopped.
  
  
  RESULTS
  Administration of clopidogrel 0.5 and 1 hour before discontinuation of the cangrelor infusion did not prevent recovery of platelet reactivity more effectively than administration at the end of the infusion.
  
  
  CONCLUSIONS
  Our results support the previously established strategy of administering clopidogrel immediately after discontinuation of cangrelor. Earlier administration increases the recovery of platelet function.
authors.affiliation: Department of Medicine, Cardiology Unit and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
authors.forename: David J
authors.initials: DJ
authors.lastname: Schneider
authors.affiliation: Department of Medicine, Cardiology Unit and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Cardiology Unit and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
authors.forename: Naveen
authors.initials: N
authors.lastname: Seecheran
authors.affiliation: Department of Medicine, Cardiology Unit and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
authors.forename: Prospero
authors.initials: P
authors.lastname: Gogo
mesh_terms: D000249:Adenosine Monophosphate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D001682:Biological Availability; D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics; D010979:Platelet Function Tests / Q000379:methods; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics
chemical_list: D010975:Platelet Aggregation Inhibitors; D000249:Adenosine Monophosphate; C117446:cangrelor; D000077144:Clopidogrel; D013988:Ticlopidine