Cangrelor

Indications

Cangrelor is used for: Indicated as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor

Adult Dose

Percutaneous Coronary Intervention 30 mcg/kg IV bolus infused over 1 minute before PCI, THEN Immediately follow bolus injection with 4 mcg/kg/min IV infusion; continue for at least 2 hr or duration of PCI, whichever is longer Transition patients to oral P2Y12 platelet inhibitor Choose from 1 of the loading-dose regimens described below to initiate oral therapy: Ticagrelor: 180 mg PO at any time during cangrelor infusion or immediately after discontinuation Prasugrel: 60 mg PO immediately after discontinuing cangrelor; do not administer prasugrel prior to cangrelor discontinuation because of drug interaction Clopidogrel: 600 mg PO immediately after discontinuing cangrelor; do not administer clopidogrel prior to cangrelor discontinuation because of drug interaction

Child Dose

Renal Dose

Administration

IV Preparation For each 50 mg/vial, reconstitute by adding 5 mL of sterile water for injection Swirl gently until all material is dissolved; avoid vigorous mixing Allow any foam to settle Ensure that vial contents are fully dissolved and the reconstituted material is a clear, colorless to pale yellow solution Do not use without dilution Before administration, each reconstituted vial must be diluted further with 0.9% NaCl or D5W Withdraw the contents from 1 reconstituted vial and add to 250-mL bag of 0.9% NaCl or D5W Mix the bag thoroughly This dilution results in a concentration of 200 mcg/mL and should be sufficient for at least 2 hr of dosing Patients who weigh ?100 kg require a minimum of 2 bags IV Administration Administer via a dedicated IV line 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 IV infusion immediately after the bolus administration

Contra Indications

Significant active bleeding Hypersensitivity

Precautions

Increased risk of bleeding; bleeding events of all severities were more common with cangrelor than with clopidogrel Lactation: Unknown if distributed in human breast milk; use caution

Pregnancy-Lactation

Pregnancy There are no available data on 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 pregnant women and fetus Disease-associated maternal and/or embryo/fetal risk Myocardial infarction is a medical emergency in pregnancy which can be fatal to 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 the drug on the fetus Animal data In animal reproduction studies, continuous infusion of drug in pregnant rats and rabbits throughout organogenesis at dose approximately 2-times maximum recommended human dose (MRHD) did not result in fetal malformations Labor or delivery Drug use during labor and delivery may increase risk for maternal bleeding and hemorrhage; performance of neuraxial blockade procedures is not advised during drug use due to potential risk of spinal hematoma; when possible, discontinue drug 1 hour prior to labor, delivery, or neuraxial blockade Lactation There are no data on presence of drug in human milk or animal milk, effects on breastfed infant, or on milk production; due to its short-half life, drug exposure is expected to be very low in breastfed infant

Interactions

Adverse Effects

Side effects of Cangrelor : Bleeding Mild (14.9%) Moderate (0.4%) Severe/life-threatening (0.2%) 1-10% Worsening renal function in patients with CrCl <30 mL/min (3.2%) <1% Hypersensitivity

Mechanism of Action

P2Y12 platelet inhibitor that blocks ADP-induced platelet activation and aggregation; it binds selectively and reversibly to the P2Y12 receptor to prevent further signaling and platelet activation