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Pharmacodynamic effects during the transition between cangrelor and prasugrel
David J Schneider1, Naveen Seecheran, Syed Sadi Raza
1Department of Medicine, Cardiology Unit, Cardiovascular Research Institute, University of Vermont, Burlington, Vermont, USA.
Coronary Artery Disease
|August 5, 2014
Summary
Cangrelor and prasugrel effectively inhibit platelet function. However, a transient recovery of platelet reactivity occurs during the transition from cangrelor to prasugrel, which is lessened by administering prasugrel 30 minutes before cangrelor cessation.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Intravenous P2Y12 antagonists like cangrelor require a transition to oral therapy.
- Understanding drug interactions during this transition is crucial for patient care.
Purpose of the Study:
- To evaluate the pharmacodynamic impact of cangrelor and prasugrel on each other.
- To assess platelet function during the switch from intravenous cangrelor to oral prasugrel.
Main Methods:
- 15 patients with stable coronary artery disease on aspirin received cangrelor infusion and varying doses of prasugrel.
- Platelet aggregation was measured using light transmission, VerifyNow, and flow cytometry.
- Pharmacodynamic assessments were conducted during and after cangrelor infusion, and on day 8 during a repeat cangrelor infusion.
Main Results:
- Cangrelor demonstrated potent platelet inhibition during infusions on both study days.
- A transient, significant recovery of platelet reactivity was observed after cangrelor cessation on day 1.
- Administering prasugrel 30 minutes prior to cangrelor discontinuation attenuated this recovery.
Conclusions:
- Prasugrel does not interfere with cangrelor's antiplatelet effects.
- A transient window of increased platelet reactivity exists when switching from cangrelor to prasugrel.
- Timing prasugrel administration 30 minutes before cangrelor cessation can mitigate this transient recovery.
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