Maintenance of Platelet Inhibition During Antiplatelet Therapy

Abstract

A method for reducing or maintaining platelet inhibition in a patient by administering cangrelor prior to an invasive procedure is described. The method of this invention can be used for patients in need of antiplatelet therapy or at risk of thrombosis. The method can further be used in patients who were previously treated with long-acting platelet inhibitors without increasing the risk of excessive bleeding.

What is claimed is: 
     
         1 . A method of maintaining P2Y 12  inhibition in a patient being treated with an oral P2Y 12  inhibitor who is in need of surgery, the method comprising:
 (a) discontinuing the treatment with the oral P2Y 12  inhibitor;   (b) administering intravenously a 0.75 μg/kg/min continuous infusion of cangrelor; and   (c) discontinuing the administration of cangrelor at least about one hour prior to administration of anesthesia for the surgery.   
     
     
         2 . The method of  claim 1 , wherein the patient has acute coronary syndrome (ACS). 
     
     
         3 . The method of  claim 1 , wherein the patient has a stent. 
     
     
         4 . The method of  claim 1 , wherein cangrelor is administered as quickly as possible following the discontinuation of treatment with the oral P2Y 12  inhibitor. 
     
     
         5 . The method of  claim 1 , wherein the oral P2Y 12  inhibitor is a thienopyridine. 
     
     
         6 . The method of  claim 5 , wherein cangrelor is administered within about 5 days of the discontinuation of treatment with the thienopyridine. 
     
     
         7 . The method of  claim 5 , wherein administration of cangrelor is discontinued after no longer than about 7 days from initiation of administration of cangrelor. 
     
     
         8 . A method of maintaining P2Y 12  inhibition in a patient being treated with a long-acting P2Y 12  inhibitor who is in need of an invasive procedure, the method comprising:
 (a) discontinuing the treatment with the long-acting P2Y 12  inhibitor;   (b) administering intravenously a 0.75 μg/kg/min continuous infusion of cangrelor; and   (c) discontinuing the administration of cangrelor at least about one hour prior to administration of anesthesia for the invasive procedure.   
     
     
         9 . The method of  claim 8 , wherein the patient is at an increased risk for thrombotic events when treatment with the long-acting P2Y 12  inhibitor is discontinued. 
     
     
         10 . The method of  claim 8 , wherein the invasive procedure is surgery. 
     
     
         11 . The method of  claim 8 , wherein cangrelor is administered as quickly as possible following the discontinuation of treatment with the long-acting P2Y 12  inhibitor. 
     
     
         12 . The method of  claim 8 , wherein the long-acting P2Y 12  inhibitor is in an oral dosage form. 
     
     
         13 . The method of  claim 12 , wherein the long-acting P2Y 12  inhibitor is a long-acting irreversible P2Y 12  inhibitor. 
     
     
         14 . The method of  claim 13 , wherein the long-acting irreversible P2Y 12  inhibitor is a thienopyridine. 
     
     
         15 . The method of  claim 14 , wherein cangrelor is administered within about 5 days of the discontinuation of treatment with the thienopyridine. 
     
     
         16 . The method of  claim 14 , wherein administration of cangrelor is discontinued after no longer than about 7 days from initiation of administration of cangrelor. 
     
     
         17 . A method of maintaining P2Y 12  inhibition in a patient with acute coronary syndrome (ACS) who is being treated with a long-acting P2Y 12  inhibitor and is at an increased risk for thrombotic events when said treatment is discontinued due to the need for surgery, the method comprising:
 (a) discontinuing the treatment with the long-acting P2Y 12  inhibitor;   (b) administering intravenously a 0.75 μg/kg/min continuous infusion of cangrelor; and   (c) discontinuing the administration of cangrelor at least about one hour prior to administration of anesthesia for the surgery.   
     
     
         18 . The method of  claim 17 , wherein cangrelor is administered as quickly as possible following the discontinuation of treatment with the long-acting P2Y 12  inhibitor. 
     
     
         19 . The method of  claim 17 , wherein the long-acting P2Y 12  inhibitor is in an oral dosage form. 
     
     
         20 . The method of  claim 19 , wherein the long-acting P2Y 12  inhibitor is a long-acting irreversible P2Y 12  inhibitor. 
     
     
         21 . The method of  claim 20 , wherein the long-acting irreversible P2Y 12  inhibitor is a thienopyridine. 
     
     
         22 . The method of  claim 21 , wherein cangrelor is administered within about 5 days of the discontinuation of treatment with the thienopyridine. 
     
     
         23 . The method of  claim 21 , wherein administration of cangrelor is discontinued after no longer than about 7 days from initiation of administration of cangrelor. 
     
     
         24 . A method of maintaining P2Y 12  inhibition in a patient with a stent who is being treated with a long-acting P2Y 12  inhibitor and is at an increased risk for thrombotic events when said treatment is discontinued due to the need for surgery, the method comprising:
 (a) discontinuing the treatment with the long-acting P2Y 12  inhibitor;   (b) administering intravenously a 0.75 μg/kg/min continuous infusion comprising cangrelor; and   (c) discontinuing the administration of cangrelor at least about one hour prior to administration of anesthesia for the surgery.   
     
     
         25 . The method of  claim 24 , wherein cangrelor is administered as quickly as possible following the discontinuation of treatment with the long-acting P2Y 12  inhibitor. 
     
     
         26 . The method of  claim 24 , wherein the long-acting P2Y 12  inhibitor is in an oral dosage form. 
     
     
         27 . The method of  claim 26 , wherein the long-acting P2Y 12  inhibitor is a long-acting irreversible P2Y 12  inhibitor. 
     
     
         28 . The method of  claim 27 , wherein the long-lasting irreversible P2Y 12  inhibitor is a thienopyridine. 
     
     
         29 . The method of  claim 28 , wherein cangrelor is administered within about 5 days of the discontinuation of treatment with the thienopyridine. 
     
     
         30 . The method of  claim 28 , wherein administration of cangrelor is discontinued after no longer than about 7 days from initiation of administration of cangrelor.