The optimal antiplatelet treatment in an emergency setting

The P2Y12 receptor is the molecular target for thienopyridines, namely clopidogrel and prasugrel, of which the active metabolites formed in the liver covalently bind to the P2Y12 receptor and also for direct, reversible antagonists such as ticagrelor, cangrelor, and elinogrel. There are several limitations of P2Y12 orally administered inhibitors especially if used in patients with acute coronary syndrome treated with PCI.Cangrelor has the advantage over all orally administered agents of being a very potent, quickly reversible and direct-acting P2Y12 antagonist, reaching consistent optimal platelet inhibition minutes after the start of the infusion. The results of three major currently available clinical trials (CHAMPION PLATFORM, CHAMPION PCI, and CHAMPION PHOENIX) show cangrelor to be relatively safe and more effective than clopidogrel in patients with acute coronary syndromes and undergoing coronary interventions. The BRIDGE study demonstrated the feasibility of the use of cangrelor as a bridging therapy in patients awaiting cardiac surgery who require prolonged platelet P2Y12 inhibition. Cangrelor is not available yet; however, the pharmacodynamic properties of cangrelor (prompt and potent onset of action and fast offset) make it a desirable drug in an emergency setting, particularly in patients undergoing coronary interventions and in patients awaiting cardiac surgery who require prolonged platelet inhibition