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Cangrelor

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https://www.readbyqxmd.com/read/29860606/cangrelor-use-prior-to-left-ventricular-assist-device-surgery-a-case-series
#1
Jeffrey B Washam, Babatunde Yerokun, Chetan B Patel, Ian J Welsby, Carmelo A Milano, Adam D DeVore
Bleeding frequently occurs in patients undergoing placement of a left ventricular assist device (LVAD). Clinical factors that have been identified as contributing to peri-procedural bleeding include LVAD implantation after an acute myocardial infarction and preoperative use of antiplatelet agents. In this report, we describe the use of cangrelor for preoperative antiplatelet bridging to LVAD in five post myocardial infarction patients with cardiogenic shock that had recently undergone percutaneous coronary intervention...
June 2, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29782272/-duration-and-timing-of-initiation-of-therapy-with-platelet-p2y12-inhibitors-in-the-treatment-of-patients-with-acute-coronary-syndrome
#2
S V SHalaev, Z M Safiullina
In recent years, the issues of choice of an agent for dual antiplatelet therapy (DAPT) as well as timing of initiation and duration of DAPT in patients with acute coronary syndrome (ACS) have been actively discussed. In this article we present data of major randomized trials of clopidogrel and novel P2Y12 inhibitors - prasugrel, ticagrelor, cangrelor - assessing strategy of administration of antiaggregants in patients with ACS before coronary angiography / percutaneous coronary intervention. The article also contains analysis of differences between recommendations of the European Society of Cardiology and American College of Cardiology/American Heart Association on therapy with oral P2Y12 inhibitors in the management of patients with ACS...
March 2018: Kardiologiia
https://www.readbyqxmd.com/read/29726596/cost-implications-of-intraprocedural-thrombotic-events-and-bleeding-in-percutaneous-coronary-intervention-results-from-the-champion-phoenix-economics-study
#3
Hector Tamez, Philip Généreux, Robert W Yeh, Amit P Amin, Weihong Fan, Harvey D White, Ajay J Kirtane, Gregg W Stone, C Michael Gibson, Robert A Harrington, Deepak L Bhatt, Duane S Pinto
BACKGROUND: Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies. METHODS: PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule...
May 4, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29665860/the-use-of-cangrelor-with-heparin-for-left-ventricular-assist-device-implantation-in-a-patient-with-acute-heparin-induced-thrombocytopenia
#4
Yan K Gernhofer, Michael Ross, Swapnil Khoche, Victor Pretorius
BACKGROUND: Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent - cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015...
April 17, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29537373/contemporary-parenteral-antiplatelet-bridging-strategies-a-single-center-real-world-experience-at-a-tertiary-care-center
#5
Gretchen Stern, Jessica Rimsans, Arman Qamar, Muthiah Vaduganathan, Deepak L Bhatt
AIMS: Oral antiplatelet therapy may require interruption soon after percutaneous coronary intervention (PCI) or acute coronary syndrome. The optimal parenteral antiplatelet bridge strategy with glycoprotein IIb/IIIa inhibitors or cangrelor, a P2Y12 inhibitor, is unclear. We explore real-world use of cangrelor or eptifibatide for antiplatelet bridging at a large tertiary-care center. METHODS AND RESULTS: Thirty-one patients (9 eptifibatide, 20 cangrelor, and 2 both) received bridge therapy from October 2015 to June 2017...
March 13, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29443372/impact-of-reticulated-platelets-on-the-antiplatelet-effect-of-the-intravenous-p2y12-receptor-inhibitor-cangrelor
#6
Christian Stratz, Thomas Nührenberg, Christian M Valina, Nikolaus Löffelhardt, Kambis Mashayekhi, Miroslaw Ferenc, Dietmar Trenk, Franz-Josef Neumann, Willibald Hochholzer
BACKGROUND:  Reticulated platelets are associated with impaired antiplatelet response to irreversibly acting P2Y12 -receptor inhibitors. However, the impact of reticluated platelets (RP) on the reversibly acting injectable P2Y12 -receptor inhibitor cangrelor is unknown. Thus, this study sought to investigate the influence of RP on cangrelor and transitioning strategies to oral P2Y12 -receptor inhibitors. METHODS:  This study randomized 110 patients undergoing elective percutaneous coronary intervention with use of cangrelor to different oral transitioning strategies loading with prasugrel 60 mg or ticagrelor 180 mg at the start of cangrelor ( n  = 45 each) or loading with clopidogrel 600 mg after discontinuation of cangrelor ( n  = 20)...
February 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29405601/the-promise-of-effective-p2y-12-platelet-receptor-pretreatment-not-crushed-yet
#7
EDITORIAL
Arka Chatterjee, William B Hillegass
Pre-treatment with intact oral clopidogrel and prasugrel tablets in a representative observational study is not associated with altered ischemic or bleeding outcomes in acute coronary syndrome (ACS) patients. Limited by cost, cangrelor, a rapidly acting intravenous P2Y12 platelet receptor inhibitor, achieved meaningful reductions in major adverse cardiovascular events (MACE) and stent thrombosis (ST) compared to oral clopidogrel pretreatment. Crushed prasugrel and ticagrelor (CP&T) administered orally achieve accepted thresholds of therapeutic platelet inhibition in one hour in approximately 2/3rds of patients compared to 1/3rd with intact oral tablets...
February 1, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29345590/what-is-the-role-for-glycoprotein-iib-iiia-inhibitor-use-in-the-catheterisation-laboratory-in-the-current-era
#8
Andrea Rubboli, Giuseppe Patti
BACKGROUND: In the era of dual antiplatelet therapy of aspirin and clopidogrel and systematic stent implantation, glycoprotein IIb/IIIa inhibitors (GPI), including abciximab, eptifibatide and tirofiban, proved beneficial in improving early outcome of percutaneous coronary intervention (PCI), especially in higher risk clinical and/or anatomical subsets. This was associated however, with an increased incidence of bleeding complications. OBJECTIVE: To review whether the established results of GPI in PCI are maintained in the contemporary era of more effective antiplatelet agents (i...
January 16, 2018: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29345586/what-is-the-role-of-cangrelor-in-patients-undergoing-pci
#9
Michal Droppa, Tobias Geisler
Dual antiplatelet therapy with aspirin and oral P2Y12-receptor inhibitors prevents ischemic events in patients undergoing percutaneous coronary intervention (PCI). However oral administration of antiplatelet drugs cause delay of onset of platelet inhibition in P2Y12-inhibitor naïve patients. Cangrelor is a novel P2Y12-receptor inhibitor which is administrated intravenously and thus allows immediate antiplatelet inhibition during PCI. Due to its unique pharmacokinetics with fast onset of platelet inhibition and very short plasma half-life it allows effective and controllable periprocedural platelet inhibition...
January 16, 2018: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29339169/the-timing-of-p2y-12-inhibitor-initiation-in-the-treatment-of-acs-does-the-evidence-exist-in-this-era
#10
REVIEW
Harsh Golwala, Deepak L Bhatt
The majority of acute coronary syndromes (ACS) are well characterized as a consequence of plaque rupture and subsequent thrombosis. Antiplatelet agents targeting inhibition of P2Y12 receptors on the platelets have been shown to reduce future risk of cardiovascular events in this patient population. However, the timing of initiation of these agents, in particular, in patients managed with an invasive strategy with percutaneous coronary interventions (PCI) is debatable. The data supporting pretreatment with antiplatelet agents prior to PCI in ACS patients date to trials performed >15 years ago, wherein the time to PCI was >5 days, and hence, the utility of pretreatment with these agents in the contemporary era remains uncertain...
January 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29339168/selection-of-p2y-12-inhibitor-in-percutaneous-coronary-intervention-and-or-acute-coronary-syndrome
#11
REVIEW
Udaya S Tantry, Eliano P Navarese, Aung Myat, Paul A Gurbel
The P2Y12 receptor plays a critical role in the amplification of platelet aggregation in response to various agonists and stable thrombus generation at the site of vascular injury leading to deleterious ischemic complications. Therefore, treatment with a P2Y12 receptor blocker is a major effective strategy to prevent ischemic complications in high-risk patients with acute coronary syndrome (ACS) and patients undergoing percutaneous coronary intervention (PCI). The determination of optimal platelet inhibition is based on maximizing antithrombotic properties while minimizing bleeding risk and is critically dependent on individual patient's propensity for thrombotic and bleeding risks...
January 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29338536/p2y-12-receptor-inhibitors-an-evolution-in-drug-design-to-prevent-arterial-thrombosis
#12
REVIEW
Danny Kupka, Dirk Sibbing
P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT), which is the superior strategy to prevent arterialthrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation.. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors. Furthermore, we describe the subsequent improvements of next-generation P2Y12 receptor inhibitors facing the ambivalent problem of bleeding events versus prevention of arterial thrombosis in a variety of clinical settings...
March 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29335817/repurposing-existing-drugs-for-new-ampk-activators-as-a-strategy-to-extend-lifespan-a-computer-aided-drug-discovery-study
#13
Sepideh Mofidifar, Farzin Sohraby, Milad Bagheri, Hassan Aryapour
Dietary restriction is one of the several ways which could putatively extend organisms' lifespan, ranging from Saccharomyces cerevisiae to rodents, by activating the AMP-activated protein kinase (AMPK), an ATP/AMP sensor. Extensive researches have shown that aging reduces sensibility of AMPK and eventually causes energy imbalance in cells. Research in mammals' AMPK depicts that this signaling molecule could control autophagy, improve cellular stress resistance and suppress inflammatory responses. Hence, in this study we performed a drug repurposing of 1908 FDA-approved drugs in order to discover putative safe activators of AMPK and to find new applications for existing drugs...
April 2018: Biogerontology
https://www.readbyqxmd.com/read/29228817/cangrelor-in-percutaneous-coronary-intervention-current-status-and-perspectives
#14
Dimitrios Alexopoulos, Christos Pappas, Danai Sfantou, John Lekakis
Cangrelor is an intravenously administered P2Y12 receptor antagonist with very fast, potent, and quickly reversible action. In the CHAMPION PHOENIX trial, cangrelor provided an improved anti-ischemic protection compared with clopidogrel, without increasing the risk of severe bleeding. Cangrelor is currently approved by drug regulating authorities for patients undergoing percutaneous coronary intervention (PCI) without prior treatment with a P2Y12 receptor antagonist and not receiving a glycoprotein IIb/IIIa inhibitor, while its use is endorsed with a class IIb recommendation by the European Society of Cardiology guidelines...
January 2018: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29057376/p2y-12-receptor-function-and-response-to-cangrelor-in-neonates-with-cyanotic-congenital-heart-disease
#15
Elisabeth A Kaza, Matthew C Egalka, Hairu Zhou, Jianchun Chen, Denise Evans, Jayne Prats, Ruizhi Li, Scott L Diamond, Julie A Vincent, Emile A Bacha, Thomas G Diacovo
Shunt thrombosis remains a major cause of morbidity and mortality, especially during the initial palliation for single-ventricle physiology. The authors present evidence that the P2Y12 inhibitor cangrelor may fill a therapeutic void in thromboprophylaxis. They base this theory on results showing that platelets from neonatal patients with cyanotic congenital heart disease have a robust response to adenosine diphosphate and are amenable to P2Y12 inhibition with cangrelor. Unique to this study was their ability to establish drug efficacy in an avatar mouse model that permits the in vivo evaluation of human platelet-mediated thrombus formation illustrating that this P2Y12 inhibitor yields the intended biological response...
August 2017: JACC. Basic to Translational Science
https://www.readbyqxmd.com/read/29036802/pharmacosimulation-of-interruptions-and-its-solution-in-intravenous-administration-of-cangrelor
#16
Maryna Masyuk, Nadia Heramvand, Johanna M Muessig, Amir M Nia, Amin Polzin, Markus Kollmann, Malte Kelm, Christian Jung
BACKGROUND: Cangrelor is an intravenous adenosine diphosphate (ADP) P2Y12 receptor antagonist, which has to be administered as a bolus followed by immediate infusion. Nevertheless, in clinical routine deviations from the correct practice, such as delayed infusion onset or interruptions during infusion, may occur. OBJECTIVE: The objective of the present study was to investigate the impact of administration delays on cangrelor concentration in a pharmacological simulation setting and to give possible solutions for the clinical practice...
2018: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/29030140/cangrelor-compared-with-clopidogrel-in-patients-with-prior-myocardial-infarction-insights-from-the-champion-trials
#17
Alon Eisen, Robert A Harrington, Gregg W Stone, Ph Gabriel Steg, C Michael Gibson, Christian W Hamm, Matthew J Price, Jayne Prats, Efthymios N Deliargyris, Kenneth W Mahaffey, Harvey D White, Deepak L Bhatt
BACKGROUND: Patients who have had a prior myocardial infarction (MI) are at increased risk for adverse outcomes after subsequent percutaneous coronary intervention (PCI). OBJECTIVE: The objective of this study is to examine the efficacy and safety of cangrelor, a potent intravenous P2Y12 inhibitor, in patients with prior MI. METHODS: Pooled data from the CHAMPION trials were examined. Prior MI was defined as a history of MI, excluding MI events at baseline...
January 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29022423/combination-antiplatelet-treatment-in-coronary-artery-disease-patients-a-necessary-evil-or-an-overzealous-practice
#18
Dimitrios Alexopoulos, Konstantinos Katogiannis, Danai Sfantou, John Lekakis
In seeking to improve care in coronary artery disease patients, further platelet inhibition has been occasionally applied beyond that provided by aspirin and a P2Y12 receptor antagonist. This review aims to offer insights about the rationale, the efficacy and safety of combination antiplatelet therapy, involving three or more agents. Overall, the use of glycoprotein (GP) IIb/IIIa inhibitors did not significantly modify the treatment effect of different antiplatelet strategies, including double vs standard clopidogrel, prasugrel vs clopidogrel, ticagrelor vs clopidogrel, cangrelor vs clopidogrel, and vorapaxar vs placebo...
May 2018: Platelets
https://www.readbyqxmd.com/read/28928091/p2y-12-antibody-inhibits-platelet-activity-and-protects-against-thrombogenesis
#19
Nicole R Hensch, Zubair A Karim, Joshua Pineda, Nicole Mercado, Fatima Z Alshbool, Fadi T Khasawneh
Given that platelet hyperactivity is known to give rise to thrombotic disorders, new and/or novel antiplatelet therapies are constantly being developed to add to, or to complement the current arsenal of agents. To this end, adenosine diphosphate (ADP) is an important platelet activator that acts by binding to the G-protein coupled P2Y1 and P2Y12 receptors. Although the contribution of the P2Y12 receptor to the genesis of thrombosis is well established, the parenteral arsenal of drugs targeting this receptor in clinical use is limited to cangrelor...
November 18, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/28844201/bivalirudin-versus-heparin-monotherapy-in-myocardial-infarction
#20
RANDOMIZED CONTROLLED TRIAL
David Erlinge, Elmir Omerovic, Ole Fröbert, Rikard Linder, Mikael Danielewicz, Mehmet Hamid, Eva Swahn, Loghman Henareh, Henrik Wagner, Peter Hårdhammar, Iwar Sjögren, Jason Stewart, Per Grimfjärd, Jens Jensen, Mikael Aasa, Lotta Robertsson, Pontus Lindroos, Jan Haupt, Helena Wikström, Anders Ulvenstam, Pallonji Bhiladvala, Bo Lindvall, Anders Lundin, Tim Tödt, Dan Ioanes, Truls Råmunddal, Thomas Kellerth, Leszek Zagozdzon, Matthias Götberg, Jonas Andersson, Oskar Angerås, Ollie Östlund, Bo Lagerqvist, Claes Held, Lars Wallentin, Fredrik Scherstén, Peter Eriksson, Sasha Koul, Stefan James
BACKGROUND: The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. METHODS: In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors...
September 21, 2017: New England Journal of Medicine
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