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American Heart Association Late-Breaking Clinical Trial Report: New Reversible Antiplatelet Drug no More Effective Than Irreversible One in PCI
Date:11/15/2009

pproved antiplatelet drug that binds irreversibly to platelets.

Those in the cangrelor group got 30 micrograms (mcg) of cangrelor per kilogram (kg) of body weight intravenously, followed by a 4 mcg/kg/per minute infusion for at least two hours. At the end of the procedure, they received a 600 milligram (mg) dose of clopidogrel.

Patients in the clopidogrel group received a standard 600 mg loading dose immediately prior to their PCI. Following the procedure all patients received a maintenance dose of 75 mg of clopidogrel and aspirin therapy (75 mg to 325 mg/day) for at least 30 days thereafter.

Patients received all other anti-clotting therapies according to care standards at their treatment site.

"There was no statistically significant difference in the primary composite endpoint (death, heart attack and ischemic revascularization at 48 hours), which affected 7.5 percent of the cangrelor group vs. 7.1 percent for the clopidogrel group," Harrington said. But, in formal non-inferiority 1160 testing, cangrelor appeared to maintain more than 60 percent of the benefit of 600 (mg) clopidogrel over placebo.

When looked at together with data from the companion trial, researchers also found a reduction in acute stent thrombosis, which are blood clots within the metal mesh stent implanted during PCI to help hold the vessel open. The two treatment groups were well balanced in baseline characteristics. It was noted that there was more minor bleeding associated with cangrelor.

This is the first study to use a 600-mg dose (instead of 300-mg dose) of clopidogrel as the comparison drug and to compare that dose to cangrelor. Cangrelor is the first drug in a class of intravenous P2Y12 receptor antagonists. It provides immediate and intense inhibition of platelet clotting, but, as opposed to clopidogrel, this effect can be reversed.

"With its fast onset and reversibility, cangrelor holds the potent
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SOURCE American Heart Association
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