Antiplatelet · P2Y12 inhibitor

Cangrelor (Kengreal)

Also called Kengreal

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Indications

Adjunct to PCI to reduce periprocedural MI, repeat revascularization and stent thrombosis in patients not on a P2Y12 inhibitor and not getting a GP IIb/IIIa inhibitor (label)
ACS patients going to PCI without oral P2Y12 pretreatment (ACC/AHA 2025 Class 2b); also used when tablets cannot be swallowed or absorbed (practice)
Bridging a recent stent while oral P2Y12 inhibitors are held before surgery, at 0.75 mcg/kg/min (BRIDGE 2012; off-label)

Mechanism of action

Cangrelor is an ATP analogue that binds the platelet P2Y12 receptor directly, selectively and reversibly (label). P2Y12 is the Gi-coupled ADP receptor: ADP binding lowers cAMP and amplifies GP IIb/IIIa activation, so blocking it blunts aggregation and thrombus growth. Unlike clopidogrel and prasugrel it needs no metabolic activation, and because the circulation dephosphorylates it within minutes, platelet function returns within an hour of stopping (label).

Pharmacology

Hematologic: platelet inhibition within 2 min of the bolus; normal function within 1 h of stopping (label)
Cardiovascular: in CHAMPION PHOENIX, death, MI, ischemia-driven revascularization or stent thrombosis at 48 h was 4.7% vs 5.9% with clopidogrel, mostly fewer periprocedural MIs; stent thrombosis 0.5% vs 0.7%; no mortality benefit (label)
Hematologic: any GUSTO bleeding 15.5% vs 10.9%, severe or life-threatening 0.2% vs 0.1% (label)
Respiratory: dyspnea 1.3% vs 0.4% (label)
Bridging: kept P2Y12 reaction units under 240 in 98.8% vs 19.0% on placebo, with CABG bleeding 11.8% vs 10.4% (BRIDGE)

Pharmacokinetics

Onset	Within 2 min (label)
Duration	Platelet function normal within 1 h of stopping (label)
Half-life	3–6 min (label)
Distribution	Vd 3.9 L (label)
Protein binding	About 97–98% (label)
Metabolism	Dephosphorylated in the blood to a nucleoside with negligible activity; no liver step (label)
Elimination	Urine 58%, feces 35% of a labeled dose (label)
Organ failure	No renal adjustment; hepatic impairment unstudied, but clearance does not depend on the liver (label)
Oral switch	Ticagrelor 180 mg during or right after the infusion; prasugrel 60 mg or clopidogrel 600 mg only after it stops (label)

Chemistry

Tetrasodium salt of an ATP analogue with methylthioethyl and trifluoropropylthio side chains and a dichloromethylene bisphosphonate; C₁₇H₂₁N₅Cl₂F₃Na₄O₁₂P₃S₂, MW 864.3 (label)
Active as given, unlike the thienopyridine prodrugs
50 mg lyophilized powder per vial with mannitol and sorbitol; reconstitute with 5 mL sterile water, then dilute; stable 12 h in D5W and 24 h in saline at room temperature (label)

Adverse effects and cautions

In the one-pagers

ACS and STEMIAntiplatelet and anticoagulant choices: Cangrelor: 30 mcg/kg IV, then 4 mcg/kg/min: 2 min; about 1 h: IV P2Y12 inhibitor at PCI

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Sources

FDA label: Kengreal (Chiesi, 2025)
FDA label: Cangrelor (Gland, 2025)
Angiolillo 2012 (BRIDGE trial)
ACC/AHA ACS guideline (2025)

For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow your local protocols and medical direction.