Table 1.

Comparison of P2Y12 inhibitors.

	Clopidogrel	Prasugrel	Ticagrelor	Cangrelor
Chemical class	Thienopyridine	Thienopyridine	Cyclopentyl-triazolopyrimidine	Adenosine triphosphate analogue
Route	Oral	Oral	Oral	Intravenous
Prodrug	Yes (pro-drug, CYP dependent, 2 steps)	yes (pro-drug, CYP dependent, 1 step)	No	No
Bioavailability	15%	79%	36%	100%
Standard dosage	600 mg LD, then 75 mg once a day	60 mg LD, then 10 mg once a day	180 mg LD, then 90 mg twice a day	30 μg/kg bolus, then 4 μg/kg/min
Reversibility of binding	Irreversible	Irreversible	Reversible	Reversible
Onset of antiplatelet effect	2–6 h	0.5–4 h	0.5–2 h	2 min
Level of platelet inhibition at steady state	40–60%	65–80%	65–80%	90–98%
Offset of antiplatelet effect	3–10 days	5–10 days	3–4 days	30–60 min
Recommended stop of treatment before surgery	5 days	7 days	3–5 days	1 h
Excretion	50% renal, 46% biliary	68% renal, 27% feces	Biliary	Not dependent on hepatic or renal clearance mechanisms
Kidney failure	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment
Dialysis or CrCl < 15 mL/min	Limited data	Limited data	Limited data	Limited data

CrCl — creatinine clearance; LD — loading dose