Cangrelor: Clinical Data, Contemporary Use, and Future Perspectives

Figures

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  Figure 1. Mechanism of action of oral and intravenous P2Y12 inhibitors on platelet receptors (A) and transition to oral platelet P2Y12 receptor inhibitors in cangrelor‐treated patients (B). CAD indicates coronary artery disease; CYP, cytochrome P450; PCI, percutaneous coronary intervention; and PLT, platelet.

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  Figure 2. Clinical results of the CHAMPION (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) PHOENIX trial. GUSTO indicates Global Use of Strategies to Open Occluded Coronary Arteries; IDR, ischemia‐driven revascularization; MI, myocardial infarction; mITT, modified intention‐to‐treat; NSTE‐ACS, non–ST‐segment–elevation acute coronary syndrome; OR, odds ratio; PCI, percutaneous coronary intervention; ST, stent thrombosis; and STEMI, ST‐segment–elevation myocardial infarction.

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  Figure 3. Use of cangrelor in patients with acute coronary syndrome (ACS). MI indicates myocardial infarction; NSTEMI, non–ST‐segment–elevation myocardial infarction; OS, oral somministration; PCI, percutaneous coronary intervention; and STEMI, ST‐segment–elevation myocardial infarction.

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  Figure 4. Design of the ARCANGELO (Italian Prospective Study on Cangrelor). Each letter (A, B, C, and D) represents a patient prototype. Orange boxes identified the Informed and Privacy Consent Form. Green diamonds identify time of discharge. Each horizontal solid line represents the period of observation of each patient, which can be either mainly entirely prospective (orange lines) or could also include, for a small proportion of patients, a retrospective period (blue lines). Cangrelor intravenous infusion could end after percutaneous coronary intervention (PCI) conclusion. Even if adherence to European Medical Agency indications41 is not required, the transition to oral platelet P2Y12 receptor inhibitors may occur before the end of cangrelor infusion, according to the product's approved summary of product characteristics (SPC).41 In these examples, patients A and B were both eligible, because the Informed and Privacy Consent Form was signed before patient discharge; in particular, patient B was not able to give consent before start of cangrelor and PCI. On the contrary, patient C provided consent after being discharged; therefore, the patient was not eligible. Also, patient D was not…

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  Figure 5. Antithrombotic drugs currently developed for the treatment of acute coronary syndrome. GP indicates glycoprotein; PAR, protease‐activated receptors; and PDI, protein disulfide isomerase.