Switching from cangrelor to oral P2Y₁₂ 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.