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Maintenance of platelet inhibition during antiplatelet therapy

a technology of antiplatelet therapy and platelet activity, which is applied in the field of platelet inhibition, can solve the problems of increased bleeding complications, vascular occlusion and ischemic damage, dual anti-platelet therapy, etc., and achieve the effect of maintaining or reducing platelet activity and not increasing the risk of bleeding

Inactive Publication Date: 2012-06-07
THE MEDICINES
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

[0017]In another aspect of this invention, a short-acting P2Y12 inhibitor is use to maintain or reduce platelet activity in patients perioperatively where oral antiplatelet therapy is contraindicated. The reversible, short-acting P2Y12 inhibitor can be administered to a patient as a bolus and or a continuous intravenous infusion.

Problems solved by technology

In a diseased state, platelet activation leads to vascular occlusion and ischemic damage.
Dual anti-platelet therapy, however, has drawbacks.
In addition patients receiving dual anti-platelet therapy experience an increased incidence of blood transfusions and bleeding complications while undergoing surgery and other invasive procedures.
Thus, for patients under dual therapy who also require surgery such as CABG sustained platelet inhibition poses an unacceptable risk of bleeding.
As a result, physicians often face the difficult choice of discontinuing clopidogrel and aspirin prior to surgery and risking a potential ischemic event in the unprotected perioperative period or delaying surgery until the time at which clopidogrel is no longer required.
Currently, no ultra short-acting platelet inhibitors are available that allow maintenance of platelet inhibition before an invasive procedure without increasing bleeding complications at the time of an invasive procedure.

Method used

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  • Maintenance of platelet inhibition during antiplatelet therapy
  • Maintenance of platelet inhibition during antiplatelet therapy
  • Maintenance of platelet inhibition during antiplatelet therapy

Examples

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example 1

[0076]Without limitations, FIG. 2 provides a brief summary as to how the methods described in the present invention may be used in a patient in need thereof. It should be understood that the method of the present invention is not limited to the procedure described in FIG. 2.

[0077]FIG. 2, shows a screening period 210 used for determining the dosage necessary for achieving platelet inhibition greater than a pre-determined level, for example, of approximately 60%. A pre-operative period 220 of up to approximately 7 days prior to surgery can be used for administration of a reversible, short-acting P2Y12 inhibitor. An intra-operative period 230 lasting from the discontinuation of the reversible, short-acting P2Y12 inhibitor to the end of surgery can be used.

[0078]During the screening period 210, the dosage of a reversible, short-acting P2Y12 inhibitor, necessary to achieve platelet inhibition greater than approximately 60% can be determined. Other suitable levels of percent inhibition ar...

example 2

[0084]FIG. 3 describes is a non-limiting exemplary method for maintaining or reducing platelet activity in patients who were previously treated with thienopyridine prior to undergoing an invasive procedure such as CABG.

[0085]In FIG. 3, a total of 207 patients were studied. Patients were included in from this study if they met all of the following criteria: 1. Must be at least 18 years of age; 2. Anticipate non-emergent coronary artery bypass graft (CABG) surgery, either “onpump” or “off-pump,” no sooner than 48 hours from randomization but no longer than 7 days from randomization, with patient to remain hospitalized until planned CABG; 3. Have received a thienopyridine (at least 75 mg of clopidogrel, 500 mg ticlopidine, or 10 mg prasugrel) within 72 hours prior to enrollment in the study for either: the treatment of an acute coronary syndrome, regardless of time from ACS, and / or as long-term preventative therapy following drug-eluting or bare metal stent treatment.

[0086]Patients wer...

example 3

[0106]In another example and in accordance with one embodiment of the present invention, the administration of the at least one reversible, short-acting P2Y12 inhibitor occurs during an invasive procedure being performed on the subject. In this manner, it is contemplated that the administration of the inhibitor would occur intravenously as the subject cannot take the therapy orally.

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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.

Description

[0001]This invention is a continuation-in-part of application serial No. 12 / 990,332 filed Oct. 29, 2010 claiming priority to PCT / US09 / 043820 filed May 13, 2009, claiming priority to provisional application no. 61 / 127, 424 filed May 13, 2008. Each of the above referenced applications is incorporated herein by reference.FIELD OF THE INVENTION [0002]The instant invention relates to the field of platelet inhibition, and in particular to methods of maintaining or reducing platelet activity in patients undergoing an invasive procedure.BACKGROUND OF THE INVENTION[0003]Anti-platelet therapy has been shown to reduce clinical ischemic events and improve outcomes for acute coronary syndrome (ACS) patients. Currently, the approved anti-platelet products include aspirin and thienopyridines, such as clopidogrel and ticlopidine. One of the most widely prescribed thienopyridines is clopidogrel, which is also known as Plavix®.[0004]Thienopyridines such as clopidogrel irreversibly inhibits P2Y12 rece...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61K39/395A61K38/48A61P7/02A61K38/55A61K38/12A61K31/7076A61K38/49
CPCA61K31/00A61K31/4365A61K31/7076A61K2300/00A61P7/02
Inventor CHEN, LISA RUDERMANSKERJANEC, SIMONBELL, DAWNPRATS, JAYNETODD, MEREDITH
Owner THE MEDICINES
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