Cangrelor 50mg powder for solution for injection vials

This systematic review investigates the biological impact of various P2Y12 receptor inhibitors on thrombus composition and inflammatory activity in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). A comprehensive literature search across four major databases identified four randomized controlled trials that met the inclusion criteria for evidence synthesis. These trials examined ticagrelor, prasugrel, cangrelor, and genotype-guided strategies in comparison to clopidogrel, assessing outcomes such as inflammatory cell infiltration, platelet reactivity, and myocardial reperfusion parameters. Overall, ticagrelor and prasugrel were associated with more favorable modulation of thromboinflammatory and vascular healing markers compared with clopidogrel; these effects were most evident in studies evaluating neutrophil infiltration, myeloperoxidase activity, and early post-PCI ischemic events. However, variations in study design, endpoints, and follow-up duration limited direct comparisons and precluded definitive conclusions. In addition, one mechanistic study protocol describing the assessment of extracellular vesicle-based biomarkers was identified but excluded from the evidence synthesis due to the absence of outcome data. Collectively, the available evidence provides preliminary mechanistic support for the hypothesis that certain P2Y12 inhibitors may exert anti-inflammatory and thrombus-modifying effects beyond their platelet-inhibiting effects. Larger, standardized, and mechanistically focused trials are warranted to validate these findings and guide precision-based antiplatelet therapy in cardiovascular disease.

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Endovascular treatment (EVT) plays a critical role in the management of acute ischemic stroke (AIS). To enhance reperfusion outcomes, intravenous antiplatelet agents such as glycoprotein IIb/IIIa inhibitors (GPIs) are commonly administered during EVT. cangrelor, a fast-acting, reversible P2Y12 inhibitor, has emerged as a potential alternative due to its rapid onset and offset of action. However, comparative data on its efficacy and safety relative to GPIs in this context are limited. This study aimed to systematically evaluate the efficacy and safety of cangrelor versus GPIs as adjunctive antiplatelet therapies during EVT in AIS patients. We conducted a systematic review and meta-analysis following PRISMA guidelines, with protocol registration on PROSPERO (CRD420251047232). A comprehensive literature search was performed in PubMed, Scopus, and Web of Science, through May 4, 2025. Studies comparing cangrelor and GPIs during EVT in AIS were included. Data on procedural success, intracranial hemorrhage, and mortality were extracted and analyzed using Review Manager 5.4. Five studies including 616 participants (cangrelor: 318, GPIs: 298) were included. No significant difference was observed between groups in achieving the modified treatment in cerebral infarction (mTICI) score ≥ 2b (RR = 1.04, 95% CI [1.00–1.09], P = 0.07), mTICI ≥ 2c (RR = 1.19 (95% CI [0.87, 1.61], P = 0.27), or mTICI ≥ 3 (RR = 1.07 (95% CI [0.81 to 1.42], p = 0.62). Safety outcomes, including symptomatic intracranial hemorrhage and mortality, were comparable. Despite limited data, current evidence indicates that cangrelor may serve as a viable alternative to GPIs in the EVT of AIS, with comparable efficacy and safety profiles. However, definitive conclusions require validation through well-designed prospective randomized trials.

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BackgroundIntravenous cangrelor and Glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa I) are current options in antiplatelet therapy during neurointerventional procedures, potentially enhancing reperfusion and preventing reocclusion. In specific conditions, these antiplatelet agents are employed as adjuvant to mechanical thrombectomy (MT), a procedure that is crucial for patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, direct comparisons of these drugs in this context remain limited.PurposeTo compare the efficacy and safety of cangrelor and GP IIb/IIIa I following MT for AIS.Data sourcesFollowing PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies involving AIS patients undergoing MT with intravenous cangrelor or GP IIb/IIIa I.Study selectionThe initial search yielded 73 studies from PubMed, 549 studies from Embase, 21 studies from Cochrane, 121 studies from Web of Science, and 342 studies from Scopus, with 1,106 studies in total. After the removal of 536 duplicates, 570 articles underwent initial screening, from which 542 were excluded based on the information provided in the abstract and title, leaving 28 articles for full-text assessment for eligibility. Ultimately, five cohort observational studies were included.Data analysisAll statistical analyses were performed using R (version 4.4.0, R Foundation for Statistical Computing, Vienna, Austria). Efficacy outcomes included successful reperfusion and favorable functional outcomes, while safety outcomes assessed symptomatic intracerebral hemorrhage (sICH), hemorrhagic transformation, and all-cause mortality. Risk ratios (RR) with 95% confidence intervals were calculated, with significance set at P ResultsFive retrospective cohort studies comprising 630 patients were included, with 191 participants in the cangrelor group (30.32%). There was no significant difference in favorable functional outcomes (RR 1.10; 0.71-1.68; P > .05; I 2 = 76%). However, cangrelor was associated with better successful reperfusion (RR 1.07; 1.01-1.13; P I 2 = 60%). All-cause mortality (RR 1.33; 0.82-2.15; P > .05; I 2 = 0%), sICH (RR 0.63; 0.33-1.23; P > .05; I 2 = 23%) and hemorrhagic transformation (RR 0.80; 0.50-1.27; P > .05; I 2 = 64%) were not significantly different between the groups.ConclusionsCangrelor shows comparable efficacy to GP IIb/IIIa I in functional outcomes, with improved reperfusion, suggesting it as a viable alternative during MT procedures. Further randomized controlled trials are needed for comprehensive evaluation.

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