Points
- Cangrelor or eptifibatide as short-acting parental antithrombotic may be considered in the first three months of post percutaneous coronary intervention as compared to aspirin and oral P2Y12 inhibitors for 6 to 12 months to prevent stent thrombosis.
- Cangrelor is a selective, reversible intravenous P2Y12 inhibitor with pharmacokinetic and pharmacodynamics properties during periprocedural.
- Cangrelor as platelet inhibitors compared to Glycoprotein IIb/IIa class competes reversibly with fibrinogen and Willebrand factor at their receptors.
- Cangrelor in periprocedural bridging used as antiplatelets is preferred compared to impaired renal function.
Summary
During dual antiplatelet therapy, Cangrelor or eptifibatide, etc., short-acting parental antithrombotics may be considered in the first three months of post percutaneous coronary intervention as compared to aspirin and oral P2Y12 inhibitors for 6 to 12 months to prevent stent thrombosis which is dependents on type of stent and patients specific.
Cangrelor is a selective, reversible intravenous inhibitor P2Y12 approved for use during PCI with placement to reduce the risk of myocardial infarction, coronary revascularization, and stent thrombosis. The short half-life of plasma is 3 to 5 minutes. According to European Society of Cardiology guidelines, dual antiplatelet therapy should be preferred in bridge trials as thienopyridines help in the periprocedural time frame. Cangrelor or placebo was used and administered for this indication at least for 48 hours than 1 to 6 hours discontinued before Coronary artery bypass surgery. Platelets testing function was used after the study to determine the reactivity of platelets as in the previous study were found that Cangrelor achieved platelet inhibition which was 98.85 concerning placebo with 19%. Cangrelor as platelet inhibitors compared to Eptifibatide and tirofiban belongs to Glycoprotein IIb/IIa class, competing reversibly with fibrinogen and Willebrand factor at their receptors so, inhibiting platelet aggregation. The half-life of gP IIb/IIIa receptor plasma is almost 2 hours, but both showed renal elimination with eptifibatide use in hemodialysis patients.
Eptifibatide is a cost-effective agent in particular patients without renal impairment. Eptifibatide has the potential to save $5.824 per patient as compared to Cangrelor, which is more attractive when compared to cangrelor and GP IIb/IIIa inhibitors. Cangrelor is more preferred for use in impaired renal function patients as antiplatelets, while GPIIb/IIIa without impaired renal function patients with low bleeding risk. Antiplatelet therapy should be selected after discussion with cardiologists, surgeons, and clinical pharmacists.
Link to the article: https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/04/12/08/To-Bridge-or-Not-to-Bridge-in-the-Periprocedural-Setting
References Ahuja, T., & Simone, P. (2022, August 8). To bridge or not to bridge in the periprocedural setting: Cangrelor versus glycoprotein iib/iia inhibitors. American College of Cardiology; American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/04/12/08/To-Bridge-or-Not-to-Bridge-in-the-Periprocedural-Setting
