title: Transition strategies from cangrelor to oral platelet P2Y12 receptor antagonists.
abstract: Cangrelor is the first parenteral antagonist of the platelet P2Y12 receptor. This direct-acting antagonist of the platelet P2Y12 receptor should be considered an adjunct to a percutaneous coronary intervention in patients who have not been adequately pretreated with platelet P2Y12 receptor antagonists at the time of the procedure. The use of cangrelor requires transition to an oral platelet P2Y12 receptor antagonist. Transition strategies have been developed on the basis of pharmacologic characteristics of platelet P2Y12 receptor antagonists, results of pharmacodynamic studies, and results from clinical trials. Cangrelor blocks the binding to the platelet P2Y12 receptor of the active metabolite of the thienopyridines, clopidogrel and prasugrel. The active metabolite of thienopyridines is present in blood for a short interval after administration. For this reason, clopidogrel should be administered after cangrelor is stopped. Prasugrel can be administered at the end of the cangrelor infusion or up to 30 min before cangrelor is stopped. Ticagrelor is also a reversible direct-acting antagonist of the platelet P2Y12 receptor. Because there is no interaction between ticagrelor and cangrelor, ticagrelor can be administered before or during the infusion of cangrelor.
authors.affiliation: Cardiology Unit, and Cardiovascular Research Institute, Department of Medicine, University of Vermont, Burlington, Vermont, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Schneider
mesh_terms: D000249:Adenosine Monophosphate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000284:Administration, Oral; D001792:Blood Platelets / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010979:Platelet Function Tests; D017410:Practice Guidelines as Topic
chemical_list: D010975:Platelet Aggregation Inhibitors; D000249:Adenosine Monophosphate; C117446:cangrelor