Switching from cangrelor to oral P2Y ₁₂ inhibitors: a focused review on drug–drug interactions

Introduction Cangrelor, the only intravenous platelet P2Y12 receptor inhibitor, is characterized by a prompt and potent platelet inhibition, with a rapid offset of action. Large-scale clinical trials have shown that cangrelor reduce peri-procedural thrombotic events among patients undergoing percutaneous coronary interventions and not pre-treated with an oral P2Y12 receptor inhibitor. However, high P2Y12 receptor occupancy provided by cangrelor raises concerns for drug-drug interactions (DDIs) when transitioning to oral P2Y12 inhibitors.Areas covered An understanding of the pharmacology of cangrelor and oral P2Y12 inhibitors is essential to define the optimal approach to transition to oral P2Y12 inhibitors without incurring the risk of DDIs. This review, based on a thorough literature search in major scientific databases (PubMed, Cochrane Library, Web of Science), synthesizes the pharmacology of cangrelor and the oral P2Y12 receptor inhibitors, providing the rationale for the occurrence of DDIs and strategies to avoid such risk.Expert opinion The timing of transition from cangrelor to oral P2Y12 inhibitors plays a crucial role in the occurrence of DDIs, especially with clopidogrel and prasugrel. Currently, no evidence suggests a DDI when transitioning to ticagrelor. Adhering to product labels and guideline recommendations is crucial for optimizing safety and efficacy of cangrelor.