P2Y12 inhibitors for the treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention: current understanding and outcomes

Alexopoulos, Dimitrios; Varlamos, Charalampos; Mpahara, Aikaterini; Lianos, Ioannis

doi:10.1080/14779072.2019.1675513

Cited by 4 publications

(3 citation statements)

References 77 publications

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“… 5 Furthermore, nausea has been reported in almost two-thirds and vomiting in nearly one-third of patients with ST-segment elevation myocardial infarction (STEMI) 1 impairing oral P2Y 12 administration. 6 , 7 These limitations may be a major concern in patients with acute coronary syndrome (ACS) undergoing emergency PCI due to the high risk of procedural thrombotic complications. 8 Cangrelor is the only intravenous P2Y 12 receptor inhibitor available for the reduction of thrombotic cardiovascular events in adult patients with CAD undergoing PCI who have not received an oral P2Y 12 inhibitor before the PCI procedure and in whom oral periprocedural therapy with P2Y 12 inhibitors is not feasible or desirable.…”

Section: Introductionmentioning

confidence: 99%

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

De Luca,

Calabrò,

Capranzano

et al. 2023

European Heart Journal Open

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Aims Cangrelor is the only intravenous P2Y12 inhibitor available. Safety, efficacy, and transitioning from cangrelor to oral P2Y12 inhibitors were recorded in patients with acute coronary syndrome (ACS). The ARCANGELO study aims to assess the safety of cangrelor on bleeding and the effects of the transition to oral P2Y12 inhibitors in a real-world setting according to the European Medical Agency’s requirement. Methods and results Adult patients with ACS undergoing percutaneous coronary intervention (PCI) receiving cangrelor were included in the study. Patients were followed for 30 days. Incidence of bleeding events, major adverse cardiac events, and transition strategy to oral P2Y12 were recorded. Among 1004 ACS patients undergoing PCI, 995 (99.1%) were eligible for the analysis; 597 (60.0%) of them had ST-segment elevation myocardial infarction. A total of 925 (93.1%) patients underwent PCI by radial catheter access, and 972 (97.2%) received drug-eluting stents. All eligible patients received bolus and cangrelor infusion between 2 and 4 h in 95% of the cases. A total of 730 patients (73.4%) received ticagrelor, 127 (12.8%) prasugrel, and 138 (13.9%) clopidogrel as transition therapy. Bleeding, according to Bleeding Academic Research Consortium (BARC) criteria, within 30 days post-PCI occurred in 5.2% of patients (95% confidence interval: 3.9–6.8%); 0.5% experienced a moderate (BARC 3), and all others mild (BARC 1–2) bleeding events. Major adverse cardiac events occurred in 14 (1.4%) patients, principally all-cause mortality (n = 6 patients) and myocardial infarction (n = 7 patients). Conclusion The use of cangrelor in ACS patients undergoing PCI and the transition strategy to P2Y12 inhibitors are confirmed as safe and effective in daily practice.

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Section: Introductionmentioning

confidence: 99%

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

De Luca,

Calabrò,

Capranzano

et al. 2023

European Heart Journal Open

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“…Despite their undoubted effectiveness, oral P2Y12 receptor inhibitors 4–7 have several limitations when they are used for the urgent or periprocedural treatment of patients with cardiovascular disease who may undergo PCI, including a delayed onset of action 8 . These limitations are critical in patients in the acute phase of cardiovascular illness, who can be sedated, intubated, in shock, or have nausea, impaired absorption, or impaired perfusion that cannot allow drug administration, limiting oral P2Y12 inhibitors bioavailability 9–13 . Nausea and vomiting have been reported in almost two‐thirds of patients with ST‐segment elevation myocardial infarction (STEMI) 14 .…”

Section: Introductionmentioning

confidence: 99%

“…8 These limitations are critical in patients in the acute phase of cardiovascular illness, who can be sedated, intubated, in shock, or have nausea, impaired absorption, or impaired perfusion that cannot allow drug administration, limiting oral P2Y12 inhibitors bioavailability. [9][10][11][12][13] Nausea and vomiting have been reported in almost two-thirds of patients with ST-segment elevation myocardial infarction (STEMI). 14 These limitations can be particularly problematic in the acute care setting surrounding PCI, making thrombotic complications during PCI a major concern.…”

Section: Introductionmentioning

confidence: 99%

Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study

Luca

Calabrò

Chirillo

et al. 2022

Clinical Cardiology

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Background:The itAlian pRospective Study on CANGrELOr (ARCANGELO) was aimed to assess the safety of using cangrelor during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) in the daily practice. Hypothesis:The safety of cangrelor after the transition to oral P2Y12 inhibitors was evaluated as the incidence of bleeding outcomes in the 30 days following PCI according to postauthorization safety study guidelines.Methods: Adults with ACS who were treated with cangrelor in one of the 28 centers involved in the study. Patients who consented to participate were followed in the 30 days following their PCI. Bleedings (Bleeding Academic Research Consortium [BARC] classification), major adverse cardiac events (MACEs), and adverse events were recorded. The interim results at two-thirds of the enrollment period are presented.Results: A total of 17 bleedings were observed in the 320 patients who completed the study at this stage. All bleedings were classified as BARC Type 1-2, except for one case of Type 3a (vessel puncture site hematoma). Four patients experienced MACEs (2 acute myocardial infarctions, 1 sudden cardiac death, 1 noncardiovascular death due to respiratory distress, and multiorgan failure). None of the bleedings was rated as related to cangrelor. Conclusions:The interim results of the ARCANGELO study provide a preliminary confirmation that the use of cangrelor on patients with ACS undergoing PCI is not associated with severe bleedings.

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Effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis

Zhang

Wang

2021

The American Journal of Emergency Medicine

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P2Y12 inhibitors for the treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention: current understanding and outcomes

Cited by 4 publications

References 77 publications

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study

Effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis

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