Article

AZD6140

Sinai Center for Thrombosis Research, Hoffberger Building, Suite 56, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Expert Opinion on Investigational Drugs (Impact Factor: 5.43). 03/2007; 16(2):225-9. DOI: 10.1517/13543784.16.2.225
Source: PubMed

ABSTRACT Oral antiplatelet therapy with P2Y(12) receptor blockers (especially clopidogrel) is the current choice of treatment during acute coronary syndromes and percutaneous interventions. To address the various limitations of thienopyridine therapy (including response variability and non-responsiveness) a novel drug, AZD6140, is under clinical development. AZD6140 is an oral and reversible P2Y(12) receptor blocker that does not require hepatic conversion to an active metabolite and produces an overall superior ADP-induced platelet inhibition with less response variability than clopidogrel. It has fast onset and offset actions that may be advantageous in patients who may have to undergo immediate surgery.

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    • "Moreover, it does not require any metabolic activation although an active metabolite has been identified with quite similar features and antiplatelet capacity thus participating in the overall antiplatelet effect. Peak plasma level of ticagrelor is reached after 1.5–3 hours and the half-life is 6–12 hours, depending on the dose [29] [30] and more than 70% is excreted via the kidney. In animal models, cangrelor inhibits ex vivo ADPinduced platelet aggregation without prolonging the bleeding times perhaps showing a fast restoration of platelet reactivity at the end of the infusion. "
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    • "Higher doses produced maximal platelet inhibition over a period of 24 h. The elimination half-life was 6–12 h (Tantry et al., 2007). "
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    ABSTRACT: ADP is one of the most important mediators of both physiologic hemostasis and thrombosis. Development and utilization of agents that block ADP receptors on the platelet membrane, namely thienopyridines, has represented a major advancement for treatment of patients undergoing percutaneous coronary interventions and those with acute coronary syndromes. Currently, clopidogrel, a second-generation thienopyridine that inhibits the ADP P2Y12 receptor, represents the treatment of choice, in addition to aspirin, for the prevention of stent thrombosis. Further, long-term adjunctive use of this ADP P2Y12 receptor antagonist is also associated with improved clinical outcomes in high-risk patients, and represents the standard of care for these patients. Despite the unambiguous clinical benefit associated with clopidogrel, accumulating experience with this drug has also led to identification of some of its drawbacks, which are related to inadequate platelet inhibition with standard dosage regimens as well as to its irreversible antiplatelet effects. This has led to the questioning of currently recommended clopidogrel dosage regimens as well as to the development of novel and more potent ADP P2Y12 receptor antagonists, some of which are also reversible agents. Numerous studies are currently ongoing with the objective of demonstrating how more potent platelet inhibition using higher loading and maintenance dose regimens of clopidogrel or novel ADP P2Y12 receptor antagonists — such as prasugrel, ticagrelor (AZD 6140) and cangrelor — will affect clinical outcomes. This article reviews the current knowledge of platelet ADP P2Y12 receptor antagonism and the projected developments in this field.
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