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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 vascular occlusion and ischemic damage, dual antiplatelet therapy, increased bleeding complications, and increased blood transfusion rates of patients receiving dual antiplatelet therapy, so as to maintain or reduce platelet activity, the effect of not increasing the risk of bleeding

Inactive Publication Date: 2013-11-14
THE MEDICINES
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

The present invention describes a method of maintaining or reducing platelet activity in a patient before an invasive procedure by administering a short-acting P2Y12 inhibitor. This method can be used in patients who have previously been treated with long-acting irreversible platelet inhibitors without increasing the risk of bleeding. The short-acting P2Y12 inhibitor can be administered as a bolus or continuous intravenous infusion. The invention also describes methods for transitioning patients from cangrelor to cangrelor during PCI or from cangrelor to cangrelor in preparation for surgery. The invention provides a safer and more effective method for maintaining or reducing platelet activity in patients undergoing invasive procedures.

Problems solved by technology

In a diseased state, platelet activation leads to vascular occlusion and ischemic damage.
Dual antiplatelet therapy, however, has drawbacks.
In addition patients receiving dual antiplatelet 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 the invasive procedure.

Method used

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  • Maintenance of Platelet Inhibition During Antiplatelet Therapy
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  • Maintenance of Platelet Inhibition During Antiplatelet Therapy

Examples

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example 1

[0093]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.

[0094]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.

[0095]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

[0101]FIG. 3 describes 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.

[0102]In FIG. 3, a total of 207 patients were studied. Patients were included in 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 “on-pump” 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; and (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.

[0103]Patients were...

example 3

[0122]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

CROSS REFERENCE TO RELATED APPLICATIONS[0001]This invention is a continuation-in-part of U.S. application Ser. No. 13 / 209,271 filed on Aug. 12, 2011, which is a continuation-in-part of U.S. application Ser. No. 12 / 990,332 filed on Aug. 15, 2011, which is a National Stage Entry of PCT / US09 / 043,820 filed on May 13, 2009, which claims priority to U.S. provisional application Ser. No. 61 / 127,424 filed on 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]Antiplatelet therapy has been shown to reduce clinical ischemic events and improve outcomes for acute coronary syndrome (ACS) patients. Currently, the approved antiplatelet products include aspirin and thienopyridines, such as clopidogrel and ticlopidine...

Claims

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Application Information

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IPC IPC(8): A61K31/7076
CPCA61K31/7076A61K9/0019A61K31/4365A61K45/06
Inventor RUDERMAN CHEN, LISASKERJANEC, SIMONABELL, DAWNPRATS, JAYNETODD, MEREDITH
Owner THE MEDICINES
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