Discover the patient types for whom KENGREAL® (cangrelor) may be appropriate during PCI
Kenneth* – A history of ACS, STEMI
Kenneth is a 66-year-old Caucasian male and a retired construction worker. He developed chest tightness radiating to his left arm while shoveling snow. This tightness was followed by nausea, vomiting, and diaphoresis. Despite taking antacids, symptoms persisted for 2 hours:
- EMS administers aspirin, oxygen, and 2 mg IV morphine sulfate
- Field ECG reveals 3 mm anterior ST-elevation
- Action: Proceeded directly to cath lab for a PCI
Medical history/social history
- Hypertension, hyperlipidemia, GERD, peptic ulcer, type 2 diabetes mellitus
- Smokes ½ pack of cigarettes per day, drinks 6 beers per week
- Simvastatin 40 mg daily
- Lisinopril 10 mg daily
- Hydrochlorothiazide 25 mg daily
- Omeprazole 40 mg daily
- Janumet XR 50/1000 mg daily
- Height 177 cm, weight 97.7 kg, BMI 31
- Pulse 110 bpm, BP 95/60 mmHg, respiratory rate 18 breaths per minute; rales are present bilaterally
- Glucose 154 mg/dL
- Proximal LAD occlusion at the origin of the first diagonal branch
- LCX with a focal 70% stenosis in a medium-sized OM2
- Dominant RCA with 80% mid-RCA stenosis, 60% PDA stenosis
- LVEF 35% with moderate anterior and apical akinesis
Rafael* – A high-risk patient, ad hoc PCI
Rafael is a 65-year-old Hispanic male and a retired mechanic. He had STEMI 2 years ago with occlusion of OM1 treated with a 3.0 x 12-mm bare-metal stent. He was lost to follow-up but recently presented to urgent care with exertional chest discomfort for the past 2–3 months, controlled by sublingual nitroglycerin. He denies rest symptoms:
- Tests: Nuclear stress test reveals lateral fixed defect with peri-infarct reversible ischemia
- Action: Scheduled for outpatient cardiac catheterization
Medical history/social history
- Hypertension, osteoarthritis, peripheral vascular disease, lumbar laminectomy, depression
- Smokes 1 pack of cigarettes per day, drinks 3 beers per day
- On disability coverage due to his back injury
- Aspirin 325 mg daily
- Ibuprofen 800 mg 3–4 times daily
- Bupropion SR 150 mg twice daily
- Enalapril 5 mg daily
- Sublingual nitroglycerin 0.4 mg prn
- Height 170 cm, weight 90.7 kg, BMI 31
- Pulse 74 bpm, BP 124/84 mmHg, respiratory rate 16 breaths per minute
- Total cholesterol 224 mg/dL
- 70% restenosis of OM1
*Not actual patients. Patient symptoms will vary; individual clinical evaluation should be done to determine best course of therapy.
IMPORTANT SAFETY INFORMATION
KENGREAL® (cangrelor) for Injection is contraindicated in patients with significant active bleeding.
KENGREAL® is contraindicated in patients with known hypersensitivity (e.g., anaphylaxis) to cangrelor or any component of the product.
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. Bleeding complications with KENGREAL® were consistent across a variety of clinically important subgroups. Once KENGREAL® is discontinued, there is no antiplatelet effect after an hour.
The most common adverse reaction is bleeding.
KENGREAL® (cangrelor) for Injection is a P2Y12 platelet inhibitor 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.