Kengrexal (Cangrelor)
Intravenous P2Y12 Platelet Inhibitor for Percutaneous Coronary Intervention
Quick Facts About Kengrexal
Key Takeaways About Kengrexal (Cangrelor)
- Rapid onset and offset: Kengrexal achieves full platelet inhibition within 2 minutes of IV administration, and platelet function returns to normal within 60 minutes of stopping the infusion
- Hospital-only medication: Kengrexal is given exclusively in hospital catheterisation laboratories during PCI procedures, under the supervision of an experienced interventional cardiologist
- Bleeding is the main risk: As an antiplatelet drug, the most significant adverse effect is bleeding, which can be serious or life-threatening in rare cases
- Transition to oral therapy is essential: Patients must be switched to an oral P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) after the Kengrexal infusion to maintain long-term antiplatelet protection
- Not for home use: Kengrexal is not self-administered – it is prepared and given by healthcare professionals in a controlled clinical setting
What Is Kengrexal and What Is It Used For?
Kengrexal (cangrelor) is an intravenous antiplatelet medication that rapidly inhibits the P2Y12 receptor on platelets, preventing blood clot formation. It is used in adult patients with coronary artery disease who are undergoing percutaneous coronary intervention (PCI) to reduce the risk of periprocedural thrombotic events, including stent thrombosis.
Kengrexal contains the active substance cangrelor, which belongs to the class of medicines known as antiplatelet agents. Platelets are very small cells in the blood that clump together and help blood to clot. While clotting is essential for wound healing, platelets can sometimes form blood clots inside a damaged blood vessel, such as a coronary artery in the heart. This can be extremely dangerous because the clot can block blood supply (a thrombotic event), leading to a heart attack (myocardial infarction).
Cangrelor works by selectively and reversibly binding to the P2Y12 receptor on the platelet surface. This receptor normally responds to adenosine diphosphate (ADP), a chemical signal that triggers platelet activation and aggregation. By blocking this receptor, cangrelor prevents ADP-mediated platelet clumping, thereby significantly reducing the risk of blood clot formation. Unlike oral P2Y12 inhibitors such as clopidogrel and prasugrel, which are prodrugs requiring hepatic conversion to an active metabolite, cangrelor is administered in its active form and does not need metabolic activation.
Kengrexal is prescribed specifically for patients with coronary artery disease (blocked heart arteries) who need a PCI procedure to open the blockage. During PCI, a cardiologist inserts a thin catheter through a blood vessel in the groin or wrist and guides it to the blocked coronary artery. A small balloon is inflated to widen the artery, and a stent (a small mesh tube) is often placed to keep the artery open. The use of Kengrexal during this procedure reduces the risk of blood clots forming around the stent or at the intervention site, which could otherwise re-block the artery.
The unique pharmacokinetic profile of cangrelor makes it particularly suited for the PCI setting. With a plasma half-life of only 3 to 6 minutes, cangrelor achieves rapid, consistent platelet inhibition that can be precisely controlled. Platelet function returns to baseline within approximately 60 minutes of discontinuing the infusion. This rapid onset and offset is a significant clinical advantage compared to oral antiplatelet agents, which may take hours to reach therapeutic effect and days for their effects to wear off.
Kengrexal was approved by the European Medicines Agency (EMA) in 2015 and by the US Food and Drug Administration (FDA) in 2015. Its approval was supported by the CHAMPION programme, a series of large randomised controlled trials (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) involving over 24,000 patients undergoing PCI. The CHAMPION PHOENIX trial demonstrated that cangrelor significantly reduced the rate of ischaemic events at 48 hours compared to clopidogrel loading at the time of PCI.
What Should You Know Before Receiving Kengrexal?
Before receiving Kengrexal, your doctor must be informed about any conditions that increase your risk of bleeding, any allergies, kidney problems, or respiratory conditions such as asthma. Kengrexal must not be used in patients with active bleeding, history of stroke or TIA, or severe uncontrolled hypertension.
Contraindications
You must not receive Kengrexal if any of the following conditions apply to you:
- Allergy to cangrelor or any other ingredient in the medicine (including mannitol, sorbitol, or sodium hydroxide)
- Active pathological bleeding – if you have a condition currently causing bleeding, such as gastrointestinal bleeding (bleeding from the stomach or intestines), or a condition that impairs your ability to stop bleeding (impaired haemostasis or irreversible coagulation disorders)
- Recent major surgery or severe physical trauma – for example, a bone fracture, major surgical procedure, or a traffic accident, as the risk of uncontrollable bleeding is significantly increased
- Severely uncontrolled high blood pressure (hypertension) – if your blood pressure is very high and not adequately treated, the combination with an antiplatelet drug could increase the risk of bleeding, particularly intracranial haemorrhage
- Previous stroke or transient ischaemic attack (TIA) – if you have ever had a stroke or “mini-stroke” caused by a temporary interruption of blood supply to the brain, the risk of intracranial bleeding is considered too high
Bleeding is the most serious risk associated with Kengrexal. Fatal bleeding events have been reported. If you experience any unexpected or prolonged bleeding during or after receiving Kengrexal, notify your healthcare team immediately. Signs of serious bleeding include blood in the urine or stools, black or tarry stools, coughing up blood, sudden severe headache, or unexpected rapid drop in blood pressure.
Warnings and Precautions
Talk to your doctor before receiving Kengrexal if any of the following apply to you:
- Increased risk of bleeding – this includes conditions that affect your blood’s ability to clot, or other medical conditions that may increase bleeding risk, such as a recent severe injury, recent surgery, previous stroke or transient ischaemic attack, or recent gastrointestinal or urinary bleeding
- Impaired kidney function or dialysis – while no specific dose adjustment has been established, patients with renal impairment may require closer monitoring as cangrelor metabolites are partially cleared by the kidneys
- Previous allergic reaction – if you have ever had an allergic reaction to Kengrexal or to any of its ingredients, inform your doctor, as re-exposure could trigger a more severe reaction
- Breathing difficulties such as asthma – dyspnoea (shortness of breath) is a known side effect of Kengrexal, and pre-existing respiratory conditions may increase this risk
- Fructose intolerance – Kengrexal contains sorbitol, which is a source of fructose. Patients with hereditary fructose intolerance (a rare genetic condition) must not receive this medicine, as they cannot break down fructose, which may cause serious adverse effects
Children and Adolescents
Kengrexal is not recommended for use in children and adolescents under 18 years of age. There is insufficient clinical data on the safety and efficacy of cangrelor in this age group. Percutaneous coronary intervention is extremely rare in paediatric patients, and the pharmacokinetics and pharmacodynamics of cangrelor have not been studied in children.
Pregnancy and Breastfeeding
If you are pregnant, think you might be pregnant, or are planning to become pregnant, tell your doctor before receiving Kengrexal. The medicine is not recommended during pregnancy because there is insufficient human data on its safety in pregnant women. Animal reproduction studies are limited, and the potential risk to the developing foetus is unknown. Your doctor will carefully assess whether the benefit of the procedure and the use of Kengrexal outweighs any potential risk.
It is not known whether cangrelor passes into human breast milk. Given that cangrelor has a very short half-life and is administered only during hospitalisation for a PCI procedure, the clinical relevance for breastfeeding is considered low. However, you should consult your doctor if you are breastfeeding.
Driving and Operating Machinery
The effects of Kengrexal wear off very rapidly (within approximately 60 minutes of stopping the infusion), and the medicine is unlikely to affect your ability to drive or use machines. However, you will have undergone a PCI procedure, and your cardiologist will advise you on when it is safe to resume driving and normal activities based on your overall recovery.
Important Information About Ingredients
Sorbitol: Kengrexal contains sorbitol, which is a source of fructose. If you have hereditary fructose intolerance, a rare inherited condition, you must not receive this medicine. Patients with hereditary fructose intolerance cannot break down fructose, which may cause serious adverse effects.
Sodium: This medicine contains less than 23 mg sodium per vial, which means it is essentially “sodium-free” and is not a concern for patients on sodium-restricted diets.
How Does Kengrexal Interact with Other Drugs?
Kengrexal interacts with other antiplatelet and anticoagulant medications, which may increase the risk of bleeding. The timing of transition from Kengrexal to oral P2Y12 inhibitors is critical – clopidogrel must not be given until immediately after the Kengrexal infusion stops, while ticagrelor or prasugrel may be given up to 30 minutes before.
Because Kengrexal is an antiplatelet agent used in an acute hospital setting during PCI, its drug interactions are primarily of concern to the treating medical team. However, understanding these interactions is important for comprehensive patient care. Cangrelor is not metabolised by cytochrome P450 enzymes and is instead rapidly dephosphorylated in the bloodstream by ectonucleotidases, which limits the potential for traditional drug–drug interactions.
The most clinically significant interaction involves the transition to oral P2Y12 inhibitors. Cangrelor binds to the same P2Y12 receptor that oral thienopyridines (clopidogrel and prasugrel) need to bind to in order to exert their antiplatelet effect. If clopidogrel is administered while cangrelor is still occupying the receptor, the active metabolite of clopidogrel cannot bind effectively, resulting in diminished antiplatelet activity. For this reason, a loading dose of clopidogrel should be administered immediately after the Kengrexal infusion is discontinued.
In contrast, ticagrelor and prasugrel have different binding characteristics. Ticagrelor is a direct-acting, reversible P2Y12 inhibitor that can effectively compete with cangrelor for receptor binding. Prasugrel’s active metabolite also demonstrates the ability to achieve therapeutic platelet inhibition despite concurrent cangrelor. Therefore, loading doses of ticagrelor or prasugrel (but not clopidogrel) may be administered up to 30 minutes before the Kengrexal infusion ends.
Significant Drug Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Clopidogrel | Oral P2Y12 inhibitor (thienopyridine) | Cangrelor blocks the P2Y12 receptor, preventing clopidogrel’s active metabolite from binding; results in reduced antiplatelet effect of clopidogrel if given concurrently | Administer clopidogrel loading dose immediately after stopping Kengrexal infusion – never during infusion |
| Warfarin / Vitamin K antagonists | Oral anticoagulant | Additive antihaemostatic effect; significantly increased bleeding risk when combined with antiplatelet therapy | Use with caution; closely monitor coagulation parameters and signs of bleeding |
| Heparin / Enoxaparin | Parenteral anticoagulant | Heparin is routinely co-administered during PCI; additive anticoagulant effect increases bleeding risk | Standard practice during PCI; monitor activated clotting time (ACT) as per institutional protocol |
| GP IIb/IIIa inhibitors (e.g. abciximab, eptifibatide, tirofiban) | Intravenous antiplatelet | Dual antiplatelet mechanism via different pathways; substantially increased bleeding risk | Combination should be avoided unless clinically essential; specialist decision only |
Transitioning to Oral P2Y12 Inhibitors
| Oral P2Y12 Inhibitor | Loading Dose | When to Administer | Notes |
|---|---|---|---|
| Clopidogrel | 600 mg | Immediately after Kengrexal infusion ends | Must NOT be given during infusion due to competitive receptor binding |
| Ticagrelor | 180 mg | Immediately after infusion, or up to 30 min before infusion ends | Can be given during infusion (up to 30 min before end) because it does not compete with cangrelor in the same way |
| Prasugrel | 60 mg | Immediately after infusion, or up to 30 min before infusion ends | Can be given during infusion (up to 30 min before end); contraindicated in patients with prior stroke/TIA |
Aspirin and Other Concomitant Medications
Patients receiving Kengrexal during PCI typically also receive aspirin (acetylsalicylic acid) as part of standard dual antiplatelet therapy. The combination of cangrelor and aspirin is well established in clinical practice and was used in the CHAMPION clinical trial programme. While the combination increases bleeding risk compared to either agent alone, the net clinical benefit in the PCI setting has been clearly demonstrated.
Because cangrelor is not metabolised by cytochrome P450 enzymes and does not significantly affect hepatic metabolism, it has minimal potential for pharmacokinetic interactions with most other medications. However, any drug that independently increases bleeding risk (such as non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, or other anticoagulants) should be used with appropriate caution.
Always inform your medical team about all medications you are currently taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements, before undergoing a PCI procedure with Kengrexal.
What Is the Correct Dosage of Kengrexal?
Kengrexal is administered as a weight-based intravenous regimen: a bolus of 30 micrograms per kilogram body weight, immediately followed by a continuous infusion of 4 micrograms per kilogram per minute for at least 2 hours. It is always given by healthcare professionals in hospital.
Your treatment with Kengrexal will be supervised by a physician experienced in treating patients with heart disease or in performing coronary interventions. The doctor will determine how much Kengrexal you receive and will prepare the medicine according to strict aseptic protocols. You will not need to manage the dosing yourself.
Adults
The recommended dose of Kengrexal for adults undergoing PCI is:
- Intravenous bolus: 30 micrograms per kilogram of body weight, given as a single injection immediately before the PCI procedure
- Intravenous infusion: 4 micrograms per kilogram per minute, started immediately after the bolus and continued for at least 2 hours, or for the entire duration of the PCI procedure, whichever is longer
- Extended infusion: Based on the physician’s clinical judgement, the infusion may be continued for up to a total of 4 hours
Dosage Example (80 kg Patient)
Bolus: 80 kg × 30 mcg/kg = 2,400 mcg (2.4 mg) as a single IV injection
Infusion: 80 kg × 4 mcg/kg/min = 320 mcg/min (0.32 mg/min) = 19.2 mg/hour
Minimum duration: 2 hours (total infusion dose: at least 38.4 mg)
Preparation and Administration
Kengrexal must be reconstituted and diluted before administration using aseptic technique:
- Reconstitution: Each 50 mg vial is reconstituted by adding 5 ml of sterile water for injection. The vial is swirled gently until all material is dissolved, avoiding vigorous mixing. Any foam is allowed to settle. The resulting concentrate contains 10 mg/ml cangrelor.
- Dilution: The reconstituted concentrate (5 ml from each vial) must be further diluted with 250 ml of sodium chloride 0.9% injection solution or 5% glucose injection solution, producing a final concentration of 200 micrograms per ml.
- Administration: Both the bolus and the infusion are administered from the diluted infusion solution. Patients weighing 100 kg or more require at least two infusion bags.
Special Populations
Elderly patients: No dose adjustment is required for elderly patients. Clinical trials included patients aged up to 90 years without the need for dose modification.
Renal impairment: No specific dose adjustment is established for patients with impaired kidney function, including those on dialysis. However, closer clinical monitoring is recommended, as cangrelor metabolites are partially renally excreted.
Hepatic impairment: No dose adjustment is required for patients with mild to moderate hepatic impairment. Cangrelor is not primarily metabolised by the liver. Patients with severe hepatic impairment have not been specifically studied.
Children and adolescents: Kengrexal is not recommended for patients under 18 years of age due to insufficient safety and efficacy data.
Overdose
Since Kengrexal is administered by a physician or nurse in a hospital setting, overdose is unlikely but remains a theoretical risk. If an overdose occurs, the physician will stop the infusion and monitor for signs and symptoms of bleeding. Due to cangrelor’s very short half-life (3–6 minutes), platelet function recovers rapidly – within approximately 60 minutes of discontinuation. There is no specific antidote for cangrelor, but its rapid clearance means that clinical effects resolve quickly. In the event of significant bleeding, standard supportive measures, including platelet transfusion, may be considered.
What Are the Side Effects of Kengrexal?
The most significant side effect of Kengrexal is bleeding, which can range from minor bruising to serious, potentially life-threatening haemorrhage. Common side effects include bruising, dyspnoea (shortness of breath), reduced blood volume or red blood cell count, and fluid leakage from injection or catheter sites. Serious allergic reactions are rare but have been reported.
Like all medicines, Kengrexal can cause side effects, although not everybody gets them. Because Kengrexal is an antiplatelet agent specifically designed to prevent blood clotting, bleeding-related events are the most frequently observed adverse reactions. The frequency and severity of bleeding depend on individual patient factors, including concomitant medications, body weight, kidney function, and the complexity of the PCI procedure.
If you experience any side effects during or after your procedure, they may require medical attention. Tell your healthcare team immediately if you notice any of the following:
Bleeding anywhere in the body – this is a common side effect that can sometimes be serious. Fatal bleeding events have been reported. Allergic reactions (rash, itching, throat tightness or swelling, swollen tongue or lips, difficulty breathing) – these are rare but can be severe.
Common Side Effects
May affect up to 1 in 10 people
- Minor bruising anywhere on the body, including small red bruises on the skin (petechiae) or bruising and swelling at injection sites
- Dyspnoea (shortness of breath)
- Bleeding leading to decreased blood volume or reduced red blood cell count (anaemia)
- Oozing or fluid leakage from injection or catheter insertion sites
Uncommon Side Effects
May affect up to 1 in 100 people
- Bleeding leading to fluid around the heart (pericardial effusion), blood in the chest cavity (haemothorax), or bleeding in the nose (epistaxis)
- Bleeding in the gastrointestinal tract, abdomen, or urinary tract
- Bleeding from injection or catheter insertion sites
- Increased blood creatinine levels (detected in blood tests), suggesting decreased kidney function
- Variations in blood pressure (hypertension or hypotension)
- Skin rash, itching (pruritus), or urticaria (hives)
- Bruising at the puncture site
Rare Side Effects
May affect up to 1 in 1,000 people
- Bleeding leading to low platelet count (thrombocytopenia) or anaemia
- Bleeding in the eye, brain (including stroke), pelvis, or lung
- Bleeding from wound sites
- Pseudoaneurysm (balloon-like swelling in an artery or heart wall affecting only a few layers of the vessel wall)
- Severe allergic reactions (anaphylaxis)
- Impaired coagulation (reduced clotting ability)
- Facial swelling
Very Rare Side Effects
May affect up to 1 in 10,000 people
- Subcutaneous bleeding or bleeding around the eye (periorbital haematoma)
- Infection at bleeding sites
- Heavy menstrual bleeding (menorrhagia)
- Bleeding from the penis, ear, or pre-existing skin tumours
Reporting Side Effects
Reporting suspected side effects after a medicine has been authorised is important because it allows continuous monitoring of the medicine’s benefit–risk balance. Healthcare professionals and patients are encouraged to report any suspected adverse reactions through their national pharmacovigilance reporting system. In the UK, reports can be made via the Yellow Card Scheme. In the EU, reports should be submitted through the national competent authority. In the US, adverse events can be reported to the FDA MedWatch programme.
How Should Kengrexal Be Stored?
Kengrexal should be stored out of the sight and reach of children, at room temperature with no special storage requirements. Once reconstituted, it should be used immediately. The diluted solution should also be used promptly unless microbiological contamination can be excluded.
The following storage instructions apply to Kengrexal:
- Unopened vials: No special storage conditions are required. Store at room temperature. Do not use after the expiry date printed on the carton after “EXP”. The expiry date refers to the last day of the stated month.
- Reconstituted concentrate: The powder should be reconstituted immediately before dilution and use. Store protected from cold (do not refrigerate the reconstituted solution).
- Diluted solution: From a microbiological perspective, the product should be used immediately after dilution. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the healthcare institution and should normally not exceed 24 hours at 2–8°C, unless reconstitution and dilution have taken place under validated aseptic conditions.
- General: Keep this medicine out of the sight and reach of children. Do not use this medicine if the reconstituted solution is not clear or contains visible particles.
What Does Kengrexal Contain?
Kengrexal contains cangrelor as the active substance (50 mg per vial). The other ingredients are mannitol, sorbitol, and sodium hydroxide for pH adjustment. After reconstitution and dilution, the final infusion solution contains 200 micrograms of cangrelor per millilitre.
Active Substance
Each glass vial contains 50 mg of cangrelor. After reconstitution with 5 ml of sterile water for injection, the concentrate contains 10 mg of cangrelor per ml. After further dilution with 250 ml of sodium chloride 0.9% or glucose 5%, the final solution contains 200 micrograms (0.2 mg) of cangrelor per ml.
Inactive Ingredients (Excipients)
- Mannitol – a sugar alcohol used as a bulking agent to help maintain the structural integrity of the freeze-dried powder
- Sorbitol – a sugar alcohol used as a stabiliser. Note: sorbitol is a source of fructose and must be avoided in patients with hereditary fructose intolerance
- Sodium hydroxide – used for pH adjustment during manufacturing to ensure optimal stability and compatibility
Appearance and Packaging
Kengrexal is supplied as a white to off-white freeze-dried (lyophilised) powder in a glass vial. It is available in packs of 10 vials. The reconstituted and diluted solution should be a clear, colourless to pale yellow liquid free from visible particles.
Manufacturer
Kengrexal is manufactured by Chiesi Farmaceutici S.p.A. (Parma, Italy) and distributed internationally through authorised partners in various countries.
Frequently Asked Questions About Kengrexal
Kengrexal (cangrelor) is an intravenous antiplatelet medication used in adult patients during percutaneous coronary intervention (PCI) – a procedure to open blocked coronary arteries. It prevents the formation of blood clots during and immediately after the procedure by blocking the P2Y12 receptor on platelets. This is particularly important when stents are placed in the coronary arteries, as blood clots can form around the stent and cause a heart attack. Kengrexal provides rapid, reversible platelet inhibition that is precisely controllable in the acute PCI setting.
The key difference is the route and speed of action. Clopidogrel, ticagrelor, and prasugrel are all oral medications that take time to reach full effect – typically 30 minutes to several hours. Kengrexal is given intravenously and achieves maximum platelet inhibition within 2 minutes. Its effects also wear off much faster (within 60 minutes of stopping the infusion, compared to days for oral agents). Additionally, clopidogrel and prasugrel are prodrugs that require liver metabolism to become active, which can be affected by genetic variations, whereas cangrelor is active in its administered form and provides consistent, predictable platelet inhibition in all patients.
Kengrexal can be used in patients with impaired kidney function, including those on dialysis, but additional monitoring may be required. While cangrelor itself is rapidly deactivated in the bloodstream (not primarily through the kidneys), some of its inactive metabolites are renally cleared. No specific dose adjustment has been established for kidney impairment, but your doctor will monitor your renal function and watch for signs of increased bleeding risk. Always inform your medical team about your kidney function before receiving Kengrexal.
Clopidogrel and cangrelor both target the P2Y12 receptor on platelets. Cangrelor occupies the receptor during its infusion, which prevents clopidogrel’s active metabolite from binding to the same site. If clopidogrel is given during the Kengrexal infusion, its effect is essentially blocked, resulting in reduced antiplatelet protection once the Kengrexal infusion ends and cangrelor clears from the system. By contrast, ticagrelor and prasugrel have different binding characteristics that allow them to be administered up to 30 minutes before the infusion ends without losing their therapeutic effect.
The approval of Kengrexal was primarily based on the CHAMPION programme of clinical trials, which included over 24,000 patients undergoing PCI. The pivotal CHAMPION PHOENIX trial (published in the New England Journal of Medicine in 2013) demonstrated that cangrelor significantly reduced the composite endpoint of death, myocardial infarction, ischaemia-driven revascularisation, and stent thrombosis at 48 hours compared to clopidogrel given at the time of PCI. These results were supported by a patient-level meta-analysis of all three CHAMPION trials, confirming the efficacy and safety of cangrelor in the PCI setting.
All information is based on the approved Summary of Product Characteristics (SmPC) from the European Medicines Agency (EMA), the FDA-approved prescribing information, peer-reviewed publications including the CHAMPION clinical trial programme, and current guidelines from the European Society of Cardiology (ESC) and the American Heart Association (AHA) / American College of Cardiology (ACC). All medical claims adhere to Evidence Level 1A, the highest quality of evidence based on systematic reviews of randomised controlled trials.
References
- Bhatt DL, Stone GW, Mahaffey KW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. New England Journal of Medicine. 2013;368(14):1303–1313. doi:10.1056/NEJMoa1300815
- Steg PG, Bhatt DL, Hamm CW, et al. Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. The Lancet. 2013;382(9909):1981–1992. doi:10.1016/S0140-6736(13)61615-3
- European Medicines Agency (EMA). Kengrexal (cangrelor) – Summary of Product Characteristics. Last updated November 2024. Available at: ema.europa.eu/kengrexal
- Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularisation. European Heart Journal. 2019;40(2):87–165. doi:10.1093/eurheartj/ehy394
- Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Journal of the American College of Cardiology. 2022;79(2):e21–e129. doi:10.1016/j.jacc.2021.09.006
- Angiolillo DJ, Firstenberg MS, Price MJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307(3):265–274. doi:10.1001/jama.2011.2002
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: World Health Organization; 2023.
- British National Formulary (BNF). Cangrelor. National Institute for Health and Care Excellence (NICE). Accessed December 2025.
Editorial Team
iMedic Medical Editorial Team – Specialists in Interventional Cardiology and Clinical Pharmacology
iMedic Medical Review Board – Independent panel reviewing all content according to ESC, AHA/ACC, and WHO guidelines
Level 1A – Based on systematic reviews and meta-analyses of randomised controlled trials (CHAMPION programme)
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