{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:28:54Z","timestamp":1761863334090,"version":"build-2065373602"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,8,13]],"date-time":"2014-08-13T00:00:00Z","timestamp":1407888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:p>Current percutaneous coronary intervention (<jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>) guidelines recommend the use of a <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>2<jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content><jats:sub>12<\/jats:sub> inhibitor with aspirin and an injectable anticoagulant. However, available oral <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>2<jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content><jats:sub>12<\/jats:sub> inhibitor therapy is limited by significant drug interactions, unclear oral absorption in selected clinical conditions, and delayed onset and offset of activity that may be cumbersome for patients requiring coronary artery bypass graft (<jats:styled-content style=\"fixed-case\">CABG<\/jats:styled-content>) surgery. Cangrelor, a novel intravenous <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>2<jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content><jats:sub>12<\/jats:sub> inhibitor, offers potential advantages compared with currently available oral agents, particularly in regard to rapid onset and offset of platelet inhibition. The Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (<jats:styled-content style=\"fixed-case\">CHAMPION)<\/jats:styled-content> trials compared cangrelor versus an oral loading dose of clopidogrel, given before or after <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>, in patients with both stable and acute coronary syndromes. The results were conflicting, but some evidence demonstrated a lower rate of stent thrombosis compared with clopidogrel and lower rates of a composite cardiovascular end point, with comparable bleeding rates. The <jats:styled-content style=\"fixed-case\">BRIDGE<\/jats:styled-content> study assessed cangrelor as a replacement for oral <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>2<jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content><jats:sub>12<\/jats:sub> inhibitors in patients awaiting <jats:styled-content style=\"fixed-case\">CABG<\/jats:styled-content> surgery and demonstrated that cangrelor maintained platelet inhibition during the preoperative period and enabled a rapid return to baseline platelet function upon cessation of the infusion. A new drug application was submitted to the Food and Drug Administration (<jats:styled-content style=\"fixed-case\">FDA<\/jats:styled-content>) for use during <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> to prevent thrombotic events and as bridging therapy for patients awaiting surgery who require therapy with <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>2<jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content><jats:sub>12<\/jats:sub> inhibitors. In February 2014, the <jats:styled-content style=\"fixed-case\">FDA<\/jats:styled-content>'s Cardiovascular and Renal Drugs Advisory Committee recommended against approval due to concerns over an appropriate risk\u2010benefit ratio for use during <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> and a lack of evidence supporting the bridging indication. On April 30, 2014, the <jats:styled-content style=\"fixed-case\">FDA<\/jats:styled-content> issued a Complete Response letter for the <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> and bridging indications, denying approval and requesting further data. The future of this once promising novel intravenous antiplatelet agent is now in question.<\/jats:p>","DOI":"10.1002\/phar.1471","type":"journal-article","created":{"date-parts":[[2014,8,13]],"date-time":"2014-08-13T17:48:11Z","timestamp":1407952091000},"page":"1061-1076","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Cangrelor: A Novel Intravenous Antiplatelet Agent with a Questionable Future"],"prefix":"10.1002","volume":"34","author":[{"given":"Laura H.","family":"Waite","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne L.","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah A.","family":"Spinler","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Pharmacy Administration Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,8,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31828124ad"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.08.007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05701-4"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"e_1_2_10_8_1","unstructured":"Daiichi Sankyo announces phase 3 study results (PRASFIT\u2010Elective Study) for the antiplatelet agent Prasugrel in Japan. 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