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cangrelor

General

Pronunciation:
kan-grel-or


Trade Name(s)

  • Kengreal

Ther. Class.
antiplatelet agents

Pharm. Class.
platelet aggregation inhibitors

Indications

Adjunct to percutaneous coronary intervention (PCI) to ↓ risk of periprocedural MI, repeat coronary revascularization or stent thrombosis in patients not currently receiving a P2Y12 platelet inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor.

Action

Inhibits platelet aggregation by reversibly interacting with platelet P2Y12 ADP-receptors, preventing signal transduction and platelet activation

Therapeutic Effect(s):

↓ risk of periprocedural MI, repeat coronary revascularization or stent thrombosis associated with PCI.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unk

Protein Binding: 97–98%

Metabolism and Excretion: Metabolized rapidly in the blood stream; metabolites do not have antiplatelet activity. 58% excreted by kidneys, 35% in feces.

Half-life: 3–6 min

TIME/ACTION PROFILE (antiplatelet effect)

ROUTEONSETPEAKDURATION
IVrapid2 min1 hr†
† following discontinuation.

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity;
  • Significant severe bleeding.

Use Cautiously in:

  • CCr <30 mL/min (↑ risk of further decline in renal function);
  • OB: Consider potential maternal benefits and fetal risks;
  • Pedi: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Resp: dyspnea

Hemat: bleeding

Misc: allergic reactions including anaphylaxis

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Route/Dosage

IV: (Adults) 30 mcg/kg bolus prior to PCI, then 4 mcg/kg/min infusion for 2 hr or duration of procedure, whichever is longer; should be followed by initiation of an oral P2Y12 platelet inhibitor.

Availability

Lyophilized powder for IV injection (requires reconstitution): 50 mg/vial

Assessment

  • Monitor for signs and symptoms of bleeding during and following infusion.
  • Monitor for signs and symptoms of hypersensitivity reaction (bronchospasm, angioedema, stridor) during therapy. Discontinue therapy and treat symptomatically.

Potential Diagnoses

Implementation

  • IV Push: Reconstitute each 50 mg vial with 5 mL of Sterile Water for injection. Swirl gently until dissolved; avoid vigorous mixing. Allow foam to settle. Solution is clear and colorless to pale yellow; do not administer solutions that are discolored or contain particulate matter. Diluent: Withdraw reconstituted solution and add to 250 mL of 0.9% NaCl or D5W. Dilute immediately. Stable for 12 hrs if diluted with D5W or 24 hrs if diluted with 0.9% NaCl at room temperature. Discard unused portion.Concentration:200 mcg/mL. Patients >100 kg will require at least 2 bags.
  • Rate: Administer rapidly over <1 min from diluted bag via IV push or pump. Ensure bolus completely administered before beginning infusion.
  • Intermittent Infusion: Start infusion immediately after administration of bolus.
  • Rate: 4 mcg/kg/min for at least 2 hrs or duration of PCI, whichever is longer.
  • Y-Site IncompatibilityInfusion requires a dedicated line.
  • To maintain platelet inhibition, administer either ticagrelor 180 mg PO at any time during or immediately after discontinuation, or prasugrel 60 mg PO or clopidogrel 600 mg PO immediately after discontinuation of infusion; do not administer prasugrel or clopidogrel prior to discontinuation of infusion.

Patient/Family Teaching

  • Caution patient to notify health care professional if bleeding occurs.
  • Advise female patient to notify health care professional if pregnancy is suspected or if breast feeding.

Evaluation/Desired Outcomes

↓ risk of periprocedural MI, repeat coronary revascularization or stent thrombosis associated with PCI.

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Citation

Quiring, Courtney, et al. "Cangrelor." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/Davis-Drug-Guide/110350/all/cangrelor.
Quiring C, Sanoski CA, Vallerand AH. Cangrelor. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://peds.unboundmedicine.com/pedscentral/view/Davis-Drug-Guide/110350/all/cangrelor. Accessed April 19, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Cangrelor. In Davis's Drug Guide. Available from https://peds.unboundmedicine.com/pedscentral/view/Davis-Drug-Guide/110350/all/cangrelor
Quiring C, Sanoski CA, Vallerand AH. Cangrelor [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 April 19]. Available from: https://peds.unboundmedicine.com/pedscentral/view/Davis-Drug-Guide/110350/all/cangrelor.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - cangrelor ID - 110350 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://peds.unboundmedicine.com/pedscentral/view/Davis-Drug-Guide/110350/all/cangrelor PB - F.A. Davis Company ET - 16 DB - Pediatrics Central DP - Unbound Medicine ER -