Drug updated on 3/28/2024
| Dosage Form | Injection (intravenous; 50 mg/ 10 mL) |
| Drug Class | P2Y12 platelet inhibitors |
| Ongoing and Completed Studies | ClinicalTrials.gov |
Indication
- Indicated as an adjunct to percutaneous coronary intervention (PCI) for reducing the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients in who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.
Summary
- Cangrelor (Kengreal) is indicated as an adjunct to percutaneous coronary intervention (PCI) for reducing the risk of periprocedural myocardial infarction, repeat coronary revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.
- A systematic review involving 44 patients showed that cangrelor offers promising safety and efficacy profiles when used in complex endovascular reperfusion procedures; it achieved successful reperfusion in 90.9% of cases without significantly increasing rates of symptomatic intracerebral hemorrhage or parenchymal hematoma.
- In comparison to clopidogrel, prasugrel, ticagrelor or aspirin combined treatments for acute coronary syndrome (ACS), cardiovascular mortality was reduced with prasugrel and ticagrelor but major adverse cardiovascular events were only reduced by prasugrel while stent thrombosis was reduced by all three including cangelror.
- For type 2 diabetes mellitus (T2DM) patients undergoing PCI, use of cangelor did not show significant difference from clopidogel regarding primary endpoint outcomes such as myocardial infarction or death within 48 hours post-PCI; however it resulted in higher mild GUSTO bleeding along with major and minor ACUITY bleedings compared to clopidogel.
- When considering perioperative administration during cardiac surgery where prevention of postoperative bleeding is critical eptifibatide tirofiban,and cangerlor are preferred over abciximab due their short half-lives allowing quicker recovery before procedures; choice should be tailored based on patient's clinical characteristics alongside institutional acquisition costs.
- The information above comes from six Systematic Reviews / Meta-Analyses documents that provide a comprehensive overview of the safety and efficacy profiles of cangrelor in different clinical scenarios.
Product Monograph / Prescribing Information
| Document Title | Year | Source |
|---|---|---|
| Kengreal (cangrelor) Prescribing Information. | 2022 | Chiesi USA, Inc., Cary, NC |
Systematic Reviews / Meta-Analyses
| Document Title | Year | Source |
|---|---|---|
| Safety and efficacy of cangrelor in acute stroke treated with mechanical thrombectomy: endovascular treatment of ischemic stroke registry and meta-analysis. | 2022 | American Journal of Neuroradiology |
| Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta analysis. | 2020 | Scientific Reports |
| Cangrelor or clopidogrel in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials. | 2019 | Diabetes Therapy |
| Meta-analysis of the role of cangrelor for patients undergoing percutaneous coronary intervention. | 2019 | The American Journal of Cardiology |
| Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus Cangrelor: Balancing Efficacy and Safety | 2019 | The Annals of pharmacotherapy |
| Meta-analysis of comparison of the newer p2y12 inhibitors (oral preparation or intravenous) to clopidogrel in patients with acute coronary syndrome | 2017 | Journal of Cardiovascular Pharmacology |
Clinical Practice Guidelines
| Document Title | Year | Source |
|---|---|---|
| 2021 ACC/AHA/SCAI guideline for coronary artery revascularization. | 2022 | Journal of the American College of Cardiology |
| 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). | 2020 | European Heart Journal |