cangrelor

General

Pronunciation:
kan-grel-or

Trade Name(s)

Kengreal

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 P2Y₁₂ADP-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)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	2 min	1 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

Concurrent use of other P2Y₁₂ inhibitors including clopidogrel, prasugrel, or tigagrelor↑ risk of bleeding.
Blocks antiplatelet effects of concurrently administered clopidogrel or prasugrel.

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

Ineffective tissue perfusion (Indications)

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 Incompatibility: Infusion 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