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Pharmacodynamic Effects When Clopidogrel is Given Before Cangrelor Discontinuation
David J Schneider1, Zubin Agarwal1, Naveen Seecheran1
1Department of Medicine, Cardiology Unit and Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
Journal of Interventional Cardiology
|September 19, 2015
Summary
Administering clopidogrel before stopping cangrelor does not improve platelet function recovery. Early clopidogrel initiation actually speeds up platelet recovery, supporting current guidelines.
Area of Science:
- Cardiovascular Pharmacology
- Platelet Biology
- Interventional Cardiology
Background:
- Cangrelor, a P2Y12 inhibitor, interacts with clopidogrel's active metabolite.
- Previous studies suggest clopidogrel administration at cangrelor's end avoids receptor competition.
- Prasugrel showed antiplatelet effects when given before cangrelor cessation.
Purpose of the Study:
- To evaluate if initiating clopidogrel before cangrelor discontinuation affects platelet reactivity recovery.
- To compare early clopidogrel administration with standard post-cangrelor dosing.
Main Methods:
- Platelet function was assessed using light transmission aggregometry, VerifyNow, and flow cytometry.
- Blood samples were from stable coronary artery disease patients on aspirin.
- Clopidogrel (600 mg) was given 0.5 and 1 hour before or immediately after cangrelor cessation.
Main Results:
- Administering clopidogrel 0.5 and 1 hour before stopping cangrelor did not enhance platelet reactivity recovery.
- Early clopidogrel initiation led to faster recovery of platelet function compared to standard timing.
Conclusions:
- The findings support the current practice of giving clopidogrel immediately after cangrelor discontinuation.
- Earlier administration of clopidogrel accelerates platelet function recovery, contrary to expectations.
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