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Intravenous P2Y12 ADP Receptor Antagonist (Direct-Acting, Reversible) Pregnancy: §8.1 Pregnancy Risk Summary, verbatim: 'There are no available data on cangrelor use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Untreated myocardial infarction can be fatal to the pregnant women and fetus. In animal reproduction studies, continuous infusion of cangrelor in pregnant rats and rabbits throughout organogenesis at dose approximately 2-times the maximum recommended human dose (MRHD) did not result in fetal malformations.' Clinical considerations: 'Myocardial infarction is a medical emergency in pregnancy which can be fatal to the pregnant woman and fetus if left untreated. Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of cangrelor on the fetus.' Labour or delivery: 'Cangrelor use during labor and delivery may increase the risk for maternal bleeding and hemorrhage.' The section is truncated at the source-fetch limit; no lactation statement was retrieved.

Cangrelor (IV P2Y12 Inhibitor — Acute PCI)

Brand names: Kengrexal

Cangrelor is an intravenous P2Y12 receptor antagonist used to reduce thrombotic events during percutaneous coronary intervention in patients not pre-treated with an oral P2Y12 inhibitor.

Adult dose

Dose: 30 micrograms/kg (30 mcg/kg) intravenous bolus before PCI, followed immediately by a 4 micrograms/kg/min (4 mcg/kg/min) intravenous infusion
Route: Intravenous, via a dedicated IV line, only after reconstitution and dilution — §2.3: 'Administer the bolus volume rapidly (<1 minute), from the diluted bag via manual IV push or pump. Ensure the bolus is completely administered before the start of PCI. Start the infusion immediately after administration of the bolus.'
Frequency: One course per PCI — §2.1: 'The maintenance infusion should ordinarily be continued for at least 2 hours or for the duration of PCI, whichever is longer.'
SCOPE: this is the label's only regimen — adjunct to percutaneous coronary intervention (PCI), which is this page's primary indication and route. VERBATIM §2.1 Recommended Dosing: 'The recommended dosage of KENGREAL is a 30 mcg/kg IV bolus followed immediately by a 4 mcg/kg/min IV infusion. Initiate the bolus infusion prior to PCI. The maintenance infusion should ordinarily be continued for at least 2 hours or for the duration of PCI, whichever is longer.' TRANSITION TO ORAL P2Y12 (§2.2, verbatim): 'To maintain platelet inhibition after discontinuation of KENGREAL infusion, administer an oral P2Y12 platelet inhibitor, as described below: Ticagrelor: 180 mg at any time during KENGREAL infusion or immediately after discontinuation. Prasugrel: 60 mg immediately after discontinuation of KENGREAL. Clopidogrel: 600 mg immediately after discontinuation of KENGREAL.' DRUG INTERACTION (§7.1, verbatim): 'Clopidogrel or prasugrel administered during KENGREAL infusion will have no antiplatelet effect until the next dose is administered. Therefore, administer clopidogrel or prasugrel after KENGREAL infusion is discontinued.' PREPARATION (§2.3): 50 mg lyophilised powder per single-use 10 mL vial (§3); 'For each 50 mg/vial, reconstitute by adding 5 mL of Sterile Water for Injection'; then 'Withdraw the contents from one reconstituted vial and add to one 250 mL saline bag... This dilution will result in a concentration of 200 mcg/mL and should be sufficient for at least 2 hours of dosing. Patients 100 kg and over will require a minimum of 2 bags.' Stability: 'Diluted KENGREAL is stable for up to 12 hours in 5% Dextrose Injection and 24 hours in Normal Saline at Room Temperature.' NO MAXIMUM DOSE is stated anywhere in the fetched label. OLDER PATIENTS (§8.5): 'In CHAMPION PHOENIX, 18% of patients were ≥75 years. No overall differences in safety or effectiveness were observed between these patients and those patients <75 years.' US labelling — confirm against the UK SPC before UK use.

Paediatric dose

Route: Not established — no paediatric route or dose is given in the fetched label
§8.4 Pediatric Use, verbatim: 'Safety and effectiveness in pediatric patients have not been established.' No paediatric regimen appears anywhere in the fetched label. The adult 30 mcg/kg bolus and 4 mcg/kg/min infusion above must NOT be extrapolated to under-18s; the weight-based calculator is deliberately disabled. Verify any paediatric use against a children's formulary and specialist advice.

Dose adjustments

Renal

Not stated — no renal-impairment dosing statement appears in any fetched section of this US label (the bundle contains §2 posology, §3 strengths, §4 contraindications, §5 warnings, §6 adverse reactions, §7 interactions, §8.1 pregnancy, §8.4 paediatric and §8.5 geriatric).

Hepatic

Not stated — no hepatic-impairment dosing statement appears in any fetched section of this US label. Verify against the UK SPC.

Dose independently re-sourced from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Significant active bleeding — §4.1, verbatim: 'KENGREAL is contraindicated in patients with significant active bleeding.'
  • Known hypersensitivity (e.g. anaphylaxis) to cangrelor or any component of the product — §4.2.
  • Not a contraindication but a §7.1 interaction rule: do not administer clopidogrel or prasugrel during the cangrelor infusion — give them only after the infusion is discontinued.

Side effects

  • Bleeding is the most common adverse reaction — §6: 'The most common adverse reaction is bleeding.'
  • CHAMPION PHOENIX non-CABG bleeding, Table 1 (cangrelor n=5529 vs clopidogrel n=5527): any GUSTO bleeding 857 (15.5%) vs 602 (10.9%); severe/life-threatening 11 (0.2%) vs 6 (0.1%); moderate 21 (0.4%) vs 14 (0.3%); mild 825 (14.9%) vs 582 (10.5%).
  • CHAMPION PHOENIX TIMI bleeding: any TIMI bleeding 45 (0.8%) vs 17 (0.3%); TIMI major 12 (0.2%) vs 6 (0.1%); TIMI minor 33 (0.6%) vs 11 (0.2%).
  • Safety database: 13,301 subjects in controlled trials, of whom 5,529 were in CHAMPION PHOENIX (§6.1). The §6.1 text is truncated at the source-fetch limit, so this is not the complete adverse-reaction list.

Monitoring

  • Watch for bleeding throughout — §5.1: 'Drugs that inhibit platelet P2Y12 function, including KENGREAL, increase the risk of bleeding. In CHAMPION PHOENIX bleeding events of all severities were more common with KENGREAL than with clopidogrel.' No laboratory or platelet-function monitoring requirement is stated in any fetched section.
  • Anticipate rapid offset when the infusion stops — §5.1: 'Once KENGREAL is discontinued, there is no antiplatelet effect after an hour.'
  • Ensure an oral P2Y12 inhibitor is given at the transition point (§2.2) so platelet inhibition is not lost when the infusion ends.

Clinical monograph

How it works

It directly and reversibly blocks the platelet P2Y12 ADP receptor, providing rapid and rapidly reversible inhibition of platelet aggregation.

Prescribing in practice

  • Bleeding is the principal risk and it should not be used where there is active significant bleeding.
  • Its very short half-life means platelet function recovers quickly after the infusion stops.
  • Timing of transition to an oral P2Y12 inhibitor matters to avoid a gap in platelet inhibition or drug interaction.

Monitoring

Monitor for bleeding during and after the infusion; routine platelet function testing is not generally required.

Counselling the patient

  • This is an intravenous antiplatelet medicine given during your heart procedure.
  • Report any bleeding or unusual bruising.
  • You will be moved onto an oral antiplatelet tablet as directed by the team.

Evidence & guidelines

The CHAMPION PHOENIX trial showed cangrelor reduced ischaemic complications during percutaneous coronary intervention compared with clopidogrel.

Reference: CHAMPION PHOENIX (Bhatt et al. NEJM 2013); ESC PCI Guidelines 2023; MHRA SPC Kengrexal; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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