Cangrelor is a potent rapid onset and offset direct P2Y12 platelet receptor inhibitor antiplatelet, blocking platelet activation and aggregation, shown to reduce thrombotic events in pts undergoing PCI. Approved in 2015 by the FDA. Dose is 30 mcg/kg IV bolus followed by 4 mcg/kg/min infusion for at least 2 hours or duration of procedure, whichever is longer. Half life is 3-6 minutes. Onset of action is about 2 minutes. Offset of action after discontinution is about 60 min. 1,2,3,4
CHAMPION PHOENIX Trial: This trial evaluated the use of cangrelor versus clopidogrel (administered as either a 300-mg or 600-mg loading dose) for preventing periprocedural complications in patients undergoing PCI. Of the 10,942 patients in the modified intention-to-treat population, 6,358 were categorized as having stable angina (SA), while 4,584 had acute coronary syndromes (ACS), including unstable angina, NSTEMI, and STEMI, at the time of randomization. The primary composite endpoint included death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis within 48 hours. A key secondary endpoint was stent thrombosis, and the primary safety endpoint focused on severe bleeding as defined by the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) criteria. 2
60 year old male presents to cardiac cath lab after witnessed v fib arrest. EMS performed ACLS for 30 minutes and achieved ROSC after amio 360mg, epinephrine x2, and multiple biphasic shocks. Pt was ventilated with supraglotic airway. Pt intubated upon arrival to cath lab. Right groin accessed and right and left heart cath performed which revealed severe multivessel coronary artery disease. Left main lesion of 60%, LAD 100%, LCX 80%, and RCA 90%. Cangrelor bolus and infusion initiated during case. Balloon angioplasty was performed on left main and LAD lesions with minimal effect.