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IV KENGREAL® (cangrelor) Information for Pharmacists
- >98% inhibition of platelet aggregation in whole blood impedance aggregometry2
- IV administration1
- Bolus followed by infusion
- Direct-acting1
- Clearance independent of renal or hepatic function1
KENGREAL pharmacology1,3
Phase I study in healthy volunteers (n=9); dose: 30 mcg/kg IV bolus + 4 mcg/kg/min IV infusion. KENGREAL blood levels and platelet activity were assessed over 150 minutes by whole blood impedance aggregometry in response to 20 μM of ADP.3
Infusion should be continued for at least 2 hours or the duration of the procedure, whichever is longer.1
KENGREAL inhibition of thrombus formation
in vivo
In this 30-second video, see the effect of KENGREAL on the thrombotic response to laser-induced injury in the mouse cremaster muscle arteriole.2,4
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Consider KENGREAL in these types of cases
- Acute coronary syndrome5
- STEMI
- NSTEMI with early invasive strategy
- Fentanyl and/or morphine coadministration in ACS6-8
- Inability to administer or reliably absorb oral medication*1
- High angiographic risk or complex anatomy9
- High-risk comorbidities (e.g., diabetes)5
- Known or potential need for surgery soon after PCI—washout avoidance*1
- Renal or hepatic impairment, or unknown renal status†1
*IV administration with onset of 2 minutes and offset within 1 hour.1
†No dosage adjustment required or renal or hepatic impairment.1
How to transition from KENGREAL
To maintain platelet inhibition after discontinuation of KENGREAL infusion, an oral P2Y12 platelet inhibitor should be administered.1
Ticagrelor
180 mg at any time during KENGREAL infusion or immediately after discontinuation
Prasugrel
60 mg immediately after KENGREAL discontinuation*
Do not administer prior to KENGREAL discontinuation
Clopidogrel
600 mg immediately after KENGREAL discontinuation*
Do not administer prior to KENGREAL discontinuation
*If prasugrel or clopidogrel is administered during KENGREAL infusion, it will have no antiplatelet effect until the next dose is administered.
The KENGREAL Cost Consequence Model
Demonstrates the economic impact of using KENGREAL versus clopidogrel with or without GPIIb/IIIa inhibitor bailout during PCI and cost avoidance of ischemic and bleeding events.
- Considered health economic and value information†
- Provides institution-specific budget impact out to 3 years
- Intended for healthcare decision makers such as cath lab directors, Quality personnel, pharmacy administration, and P&T Committee members
†Health economic and value information can be provided to a payor, formulary committee, or other similar entity with knowledge and expertise in the area of healthcare economic analysis, carrying out its responsibilities for the selection of drugs for coverage or reimbursement.
Ordering KENGREAL
Supplied as a sterile lyophilized powder in single-use 10 mL vials, each containing 50 mg of KENGREAL.
- NDC 10122-620-01: 10 mL vial containing 50 mg of KENGREAL
Storing and handling KENGREAL
KENGREAL vials should be stored at USP Controlled Room Temperature [20°C to 25°C (68°F to 77°F) with excursions between 15°C and 30°C (59°F and 86°F) permitted].1
Need help?
For additional assistance or questions not answered on this website, contact Chiesi USA, Inc. Customer Service at 1-866-466-6503.
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.
Indication
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.
References: 1. KENGREAL® (cangrelor) Prescribing Information. 2020. 2. Data on File. Chiesi USA, Inc. 3. Akers WS, Oh JJ, Oestreich JH, Ferraris S, Wethington M, Steinhubl SR. Pharmacokinetics and pharmacodynamics of a bolus and infusion of cangrelor: a direct, parenteral P2Y12 receptor antagonist. J Clin Pharmacol. 2010;50(1):27-35. 4. Stalker TJ, Traxler EA, Wu J, et al. Hierarchical organization in the hemostatic response and its relationship to the platelet-signaling network. Blood. 2013;121(10):1875-1885. 5. Bhatt DL, Stone GW, Mahaffey KW, et al; CHAMPION PHOENIX Investigators. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368(14):1303-1313. 6. BRILINTA® (ticagrelor) Prescribing Information. 2021. 7. EFFIENT® (prasugrel) Prescribing Information. 2019. 8. PLAVIX® (clopidogrel) Prescribing Information. 2021. 9. Stone GW, Généreux P, Harrington RA, et al. Impact of lesion complexity on peri-procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention: core laboratory analysis from 10,854 patients from the CHAMPION PHOENIX trial. Eur Heart J. 2018;39(46):4112-4121.