Cangrelor

Table of contents

• What is cangrelor?
• How does cangrelor work?
• Which conditions is cangrelor used or studied for?
• How is cangrelor given?
• What do the clinical trials show?
• What side effects are known?

What is cangrelor?

Cangrelor is a direct P2Y12 platelet receptor inhibitor that blocks ADP-induced platelet activation and aggregation.^[2] It belongs to the class of medicines called platelet aggregation inhibitors.^[2] Other names for the same substance include cangrelor tetrasodium, AR-C69931XX, AR-C69931MX, ARL69931, and the trade name Kengreal.^[2] Cangrelor is authorised as a medicine, according to the registry records for the trial described on this page.^[1] The registry name for the substance is CANGRELOR, and in the trial it is the tested substance.^[1]

How does cangrelor work?

Cangrelor works by directly blocking the P2Y12 receptor on platelets. This receptor normally responds to ADP, a signal that makes platelets clump together. By blocking it, cangrelor reduces platelet activation and aggregation, which lowers the chance of unwanted blood clots forming.^[2] Unlike some other antiplatelet medicines, cangrelor is given intravenously, which allows the effect to start quickly and to be controlled during a procedure.^[2]

Which conditions is cangrelor used or studied for?

• Ischemic stroke with large artery occlusion — the trial studies cangrelor in people who have a blocked large artery in the front part of the brain and also a narrowed carotid artery in the neck that needs a stent during emergency clot removal.^[1]
• Coronary artery disease — earlier research has studied cangrelor in people with coronary artery disease, as reported in a meta-analysis of four randomised trials.^[3]

How is cangrelor given?

Cangrelor is given intravenously, according to the registry records for the trial.^[1] In the trial, the dose recorded for cangrelor is 1455 micrograms per kilogram given intravenously.^[1] The comparison medicines in the trial are clopidogrel, given orally at a dose of 300 milligrams, and acetylsalicylic acid, given orally or as an intravenous infusion at a dose of 500 milligrams.^[1]

What do the clinical trials show?

One registered clinical trial investigates cangrelor as the tested substance.^[1] The trial is a Phase 2 interventional study with a planned enrolment of 50 participants.^[1] It is currently authorised, meaning it has received approval to begin.^[1]

The trial includes people with acute ischemic stroke and a blocked large artery in the intracranial carotid artery or the first two segments of the middle cerebral artery. Participants must also have a symptomatic narrowing of at least 50% in the extracranial carotid artery that requires mechanical thrombectomy and emergency carotid artery stenting.^[1]

The main outcome measured in the trial is carotid artery stent patency at 24 hours after stenting, with a window of plus or minus 6 hours.^[1] The trial compares intravenous cangrelor with oral clopidogrel and acetylsalicylic acid.^[1]

What side effects are known?

Because cangrelor reduces platelet activity, the main concern is a higher risk of bleeding. In a meta-analysis of four randomised trials in people with coronary artery disease, researchers assessed major adverse cardiac events as the primary efficacy endpoint and major bleeding as a safety outcome.^[3] The available sources do not provide a detailed list of side effects from the stroke trial itself.