Potential cases for KENGREAL® (cangrelor)

Learn about clinical cases where KENGREAL may be appropriate.

Consider KENGREAL in these cases:

  • Acute coronary syndrome (STEMI and NSTEMI)
  • Fentanyl and/or morphine coadministration
    • Opioids are known to interfere with the absorption of oral P2Y12 inhibitors
  • High angiographic risk or complex anatomy
  • Known or potential need for surgery soon after PCI
  • Inability to administer or reliably absorb oral medication
  • High-risk comorbidities (e.g., diabetes)
  • Renal or hepatic impairment, or unknown renal status

PCI case profiles

Not actual patients. Patient symptoms will vary; individual clinical evaluation should be done to determine the best course of therapy.

Emergent case–absorption issues

Angiogram of emergent case–absorption issues
Emergent case–absorption issues: Angiogram of proximal LAD occlusion at the origin of the first diagonal branch

Proximal LAD occlusion at the origin of the first diagonal branch

Presentation

  • Developed chest tightness radiating to left arm while shoveling snow, followed by diaphoresis
  • Symptoms persisted for 2 hours before 911 was called
  • Semi-responsive 76-year-old male arrives at ED via ambulance

Exam and lab values

  • ECG shows 1 mm of ST elevation in 2 contiguous leads
  • Pulse 110 bpm, BP 90/55 mmHg
  • Respiratory rate 22 breaths/min
  • Height, 177 cm; weight, 97.7 kg; BMI, 31

Medical history

  • Type 2 diabetes mellitus; last A1c was 11.2%
  • CKD stage 3
  • Hyperlipidemia
  • Controlled hypertension

Antiplatelet history

  • No antiplatelet preload

BMI=body mass index; bpm=beats per minute; CKD=chronic kidney disease;

ED=emergency department; ECG=electrocardiogram; LAD=left anterior descending artery.

STEMI–morphine or fentanyl coadministration

Angiogram of STEMI–morphine or fentanyl coadministration
STEMI: Angiograms of thrombotic total occlusion of the mid LAD and evidence of fresh thrombus
STEMI: Angiograms of thrombotic total occlusion of the mid LAD and evidence of fresh thrombus
  • Thrombotic total occlusion of the mid LAD
  • Evidence of fresh thrombus

Presentation

  • 62-year-old male, arrives at hospital via ambulance; patient vomited on the way to the hospital
  • Acute onset of crushing chest pain 60 minutes ago
    • Morphine administered by EMS

Exam and lab values

  • Pulse 98, BP 148/94 mmHg, respiratory rate 22 breaths/min
  • Height, 165 cm; weight, 93.0 kg; BMI, 34

Medical history

  • Hyperlipidemia
  • Smokes 1 pack of cigarettes per day

Antiplatelet history

  • 81 mg aspirin daily
  • No other antiplatelet preload

ECG: image with 5 mm of ST elevation in anterior leads
  • 5 mm of ST elevation in anterior leads

BMI=body mass index; BP=blood pressure; EMS=emergency medical services; LAD= left anterior descending artery.

NSTEMI–high-risk anatomy

Angiogram of NSTEMI–high-risk anatomy
NSTEMI: Angiograms of 80% occlusion of the proximal LAD, bifurcated lesion involving the circumflex artery, and evidence of calcification
NSTEMI: Angiograms of 80% occlusion of the proximal LAD, bifurcated lesion involving the circumflex artery, and evidence of calcification
  • 80% occlusion of the proximal LAD
  • Bifurcated lesion involving the circumflex artery
  • Evidence of calcification

Presentation

  • 76-year-old female developed dyspnea, epigastric discomfort, dizziness, and nausea while gardening
  • Experienced shortness of breath while walking dog daily over past 2 weeks
  • Experiences stuttering discomfort at rest accompanied by labile T-wave abnormality in the anterior leads

Exam and lab values

  • Troponin elevated, 2x ULN
  • Chest pain despite medical management
  • Pulse 92, BP 152/82 mmHg, respiratory rate 14 breaths/min
  • Height, 160 cm; weight, 72.4 kg; BMI, 28

Medical history

  • History of recent GI bleed; drinks 2 glasses of wine daily
  • High risk for bypass, refuses surgery
  • Type 2 diabetes mellitus, last A1c 8.2%
  • Hyperlipidemia

Antiplatelet history

  • No other antiplatelet preload

BMI=body mass index; BP=blood pressure; GI=gastrointestinal; ULN=upper limit of normal; LAD=left anterior descending artery.

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.

Reference: 1. KENGREAL® (cangrelor) Prescribing Information. 2016.