Search
cangrelor (Kengreal)
Investigational intravenous agent. FDA approval recommended [3]
Indications:
- platelet inhibition in association with PCI; no better than clopidogrel for patients undergoing PCI for acute coronary syndromes [1]
Benefit/risk:
- number needed to harm:
- 170 to result in 1 serious hemorrhage vs 275 for clopidogrel [4]
Dosage:
- 30 ug/kg bolus & 4 ug/kg infusion followed by 600 mg of clopidogrel at termination of infusion [2]
- continue with aspirin 81 mg QD + clopidogrel 75 mg QD
Pharmacokinetics:
- rapid onset of action (more rapid than clopidogrel)
- short half-life that allows normalization of platelet function within 60 minutes of discontinuation
Adverse effects:
- greater risk of serious bleeding than with clopidogrel [4]
Mechanism of action:
- reversibly inhibits platelet P2Y12 purinoceptor (adenosine diphosphate receptor)
Interactions
drug adverse effects of antiplatelet agents
General
antiplatelet agent
References
- Harrington RA et al
Platelet inhibition with cangrelor in patients undergoing PCI.
N Engl J Med. 2009 Dec 10;361(24):2318-29. Epub .
PMID: 19915221
http://dx.doi.org/10.1056/NEJMoa0908628
- Kastrati A and Ndrepepa G. Cangrelor - A champion lost in
translation?
N Engl J Med. 2009 Dec 10;361(24):2382-4
PMID: 19915223
http://dx.doi.org/10.1056/NEJMe0910677
- Bhatt DL et al.
Effect of platelet inhibition with cangrelor during PCI
on ischemic events.
N Engl J Med 2013 Mar 10
PMID: 23473369
http://www.nejm.org/doi/full/10.1056/NEJMoa1300815
- Lange RA and Hillis LD.
The duel between dual antiplatelet therapies.
N Engl J Med 2013 Mar 10
PMID: 23473370
http://www.nejm.org/doi/full/10.1056/NEJMe1302504
- Hustin L, Chavey WE
Cangrelor Finally Gets Nod from FDA Advisory Panel.
Physician's First Watch, April 17, 2015
David G. Fairchild, MD, MPH, Editor-in-Chief
Massachusetts Medical Society
http://www.jwatch.org
- FDA News Release. June 22, 2015
FDA approves new antiplatelet drug used during heart procedure.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm452172.htm