Phenotyping the Use of Cangrelor in Percutaneous Coronary Interventions

TL;DR

This review discusses the use of cangrelor, an intravenous antiplatelet drug, in coronary interventions and identifies the best patient profiles for its use.

Contribution

The paper provides a clinical overview and identifies optimal patient phenotypes for cangrelor use in percutaneous coronary interventions.

Findings

Cangrelor offers rapid antiplatelet effects compared to oral agents.

It is particularly useful in patients with cardiogenic shock or requiring immediate platelet inhibition.

The review highlights clinical evidence and algorithms for integrating cangrelor into practice.

Abstract

The use of antiplatelet agents is essential in percutaneous coronary interventions, both periprocedurally and in the post-interventional period. Procedural antiplatelet therapy, aiming to limit ischemic complications, is mostly administered with oral agents, including aspirin and P2Y12 inhibitors. However, there are several limitations in the use of oral P2Y12 inhibitors, including their difficult administration in patients presenting with cardiogenic shock and their relatively slower onset of action, leaving a significant period of the procedure with a suboptimal antiplatelet effect. These pitfalls could be avoided with the use of cangrelor, the only available intravenous P2Y12 inhibitor, which has a rapid onset and offset antiplatelet effect, as well as a favorable pharmacological profile. The use of cangrelor has been increasing in recent years, with several studies aiming to determine what the optimal patient phenotype to receive such treatment ultimately is and how its use could be adjunctive to oral P2Y12 inhibitors. Therefore, the aim of this review is to provide an overview of the pharmacological profile of cangrelor and an update regarding the clinical evidence supporting its use, as well as to discuss the optimal patient phenotype, related clinical algorithms, and future implications for larger implementation of this agent into everyday clinical practice.

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