cangrelor: clinical use

Prescribing considerations

• Restricted to specialised acute hospital use by clinicians experienced in coronary intervention or acute coronary care.
• Confirm that the patient fits the licensed PCI population and has not already received an oral P2Y12 inhibitor.
• Assess bleeding risk, recent surgery or trauma, blood pressure, previous cerebrovascular events and concomitant medicines.
• Plan transition to oral P2Y12 treatment while accounting for medicine-specific interactions.
• Use caution in severe renal impairment because increased bleeding and worsening renal function were reported.
• Check for hereditary fructose intolerance because the formulation contains sorbitol.

Contraindications and cautions

• Active bleeding or increased bleeding risk due to impaired haemostasis, irreversible coagulation disorders, recent major surgery or trauma, or uncontrolled severe hypertension
• Any history of stroke or transient ischaemic attack
• Hypersensitivity to cangrelor or an excipient

Monitoring

• Monitor vascular-access sites and other potential bleeding sites; investigate unexplained hypotension or a fall in haemoglobin or haematocrit.
• Observe for hypersensitivity, angioedema, anaphylaxis and clinically significant breathlessness.
• Consider renal-function monitoring, particularly in severe renal impairment.
• Ensure continuity of antiplatelet treatment when transitioning to an oral P2Y12 inhibitor.

Clinical pharmacology

Cangrelor is a selective, direct and reversible P2Y12 antagonist with rapid platelet inhibition. It is deactivated in plasma by dephosphorylation independently of hepatic CYP metabolism. Its half-life is only a few minutes, and platelet function generally returns within an hour of stopping.

Formulation and product differences

• The selected product is a white to off-white powder for concentrate for intravenous injection and infusion.
• It must be reconstituted and further diluted before use; the prepared solution should be inspected for particles.
• The formulation contains sorbitol and is essentially sodium-free.

Injection

Route: Parenteral

Strengths: 50 mg