Cangrelor for the management and prevention of arterial thrombosis

INTRODUCTION: Despite advances in antiplatelet therapy, the optimum antithrombotic regimen during percutaneous coronary intervention (PCI) remains to be determined. Cangrelor is an intravenous, reversibly-binding platelet P2Y12 receptor antagonist with ultra-rapid onset and offset of action that is approved in Europe and United States for use in patients undergoing PCI. This article describes the background for the development of cangrelor, the biology, pharmacology and clinical evidence supporting its use, and its likely position in the future. AREAS COVERED: The role of the platelet P2Y12 receptor in platelet biology and the implications of this for atherothrombotic disease are described. Currently unmet needs in antithrombotic management during and after PCI are discussed followed by a description of the chemistry, pharmacokinetics and pharmacodynamics of cangrelor, including its interactions with oral thienopyridines. Subsequently, the clinical trial evidence supporting its adoption into clinical practice is reviewed, including the evidence indicating its superiority over a strategy based on clopidogrel treatment alone. Expert commentary: The current status and future potential of cangrelor is discussed, including a view of its place in current clinical practice.