cangrelor

Inhibits platelet aggregation by reversibly interacting with platelet P2Y₁₂ADP-receptors, preventing signal transduction and platelet activation

Therapeutic effects:

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

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Protein Binding: 97–98%.

Metabolism/Excretion: Metabolized rapidly in the bloodstream; 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.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Significant severe bleeding.

Use Cautiously in:

OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Hemat: bleeding

Resp: dyspnea

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of other P2Y12 inhibitors, including clopidogrel, prasugrel, or ticagrelor, ↑ risk of bleeding.
Blocks antiplatelet effects of concurrently administered clopidogrel or prasugrel; administer clopidogrel or prasugrel after cangrelor infusion is discontinued.

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 injection: 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.

Implementation ⬆ ⬇

Reconstitution: 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 hr if diluted with D5W or 24 hr 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 hr 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.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is suspected or if breastfeeding. Avoid neuraxial blockade procedures and, when possible, discontinue cangrelor 1 hr prior to labor, delivery, or neuraxial blockade.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇