Subcutaneous RUC-4 for acute myocardial infarction: a new treatment on the horizon for pre-hospital care?

The oral P2Y12 inhibitors prasugrel and ticagrelor are recommended in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI); however, they are associated with high residual platelet reactivity (HRPR) up to 4-6 hours after loading1. On-treatment HRPR correlates with procedural success, myocardial damage and clinical outcomes. Hence, more rapid antiplatelet agents remain desirable in STEMI. Cangrelor is an intravenous (IV) P2Y12 inhibitor with a rapid and reversible antiplatelet effect, though it prompts a lower inhibition of platelet aggregation (IPA) at light transmittance aggregometry (LTA) than tirofiban, an intravenous glycoprotein IIb/IIIa inhibitor (GPI)2. Moreover, cangrelor ...