Cangrelor in percutaneous coronary interventions: advances in evidence, clinical applications, and future directions.

Introduction: Cangrelor is the only parenteral P2Y₁₂ receptor antagonist currently recommended for the prevention of periprocedural thrombotic complications in P2Y₁₂ inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI).

Areas covered: This review provides a comprehensive analysis of the pharmacological properties and administration strategies of cangrelor in PCI, summarizes the latest evidence from clinical trials and real-world studies, and discusses potential future directions for its application in clinical practice. Literature search was conducted using PubMed up to May 2025.

Expert opinion: Cangrelor provides rapid platelet inhibition following an intravenous bolus, and its short half-life ensures predictable pharmacokinetic profile, facilitating perioperative management. The CHAMPION program demonstrated that cangrelor significantly reduces early ischemic events, including myocardial infarction and stent thrombosis, compared with clopidogrel in patients undergoing PCI. Since its approval, several clinical trials and observational studies have further evaluated the efficacy and safety of cangrelor and its optimal use. The adoption of cangrelor in catheterization laboratories worldwide remains inconsistent, with misuse being frequently reported. Drug-related costs along with concerns surrounding drug interaction when switching to oral P2Y₁₂ inhibitors, limited safety data in high-risk populations and lack of evidence on the comparison against ticagrelor or prasugrel may contribute to its restricted utilization in clinical practice.