ACP Journal Club. Cangrelor reduced ischemic PCI complications more than clopidogrel without increasing severe bleeding.

Commentary Clopidogrel, a prodrug with variable metabolism to the active form, has delayed onset of action often resulting in need for a glycoprotein IIb/IIIa–receptor inhibitor to ensure adequate platelet inhibition in patients having PCI, but at the expense of increased bleeding. Prasugrel and ticagrelor are new oral antiplatelet agents that overcome some clopidogrel disadvantages: Prasugrel reduces ischemic events in PCI patients but increases bleeding (1), and ticagrelor reduces ischemic events and mortality with minimal increase in bleeding (2). The antiplatelet effects of these agents persist for several days and delay urgent CABG if needed in patients with ACS.