TM Owner Chiesi USA, Inc.
Kengreal 50mg Injection, lyophilized powder for solution
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Indications & Clinical Uses
- Kengreal 50 mg single-use vials contain cangrelor, a fast-acting intravenous P2Y12 platelet inhibitor - an antiplatelet medicine, not an anticoagulant.
- It is approved in the United States as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction, repeat coronary revascularisation and stent thrombosis in adults who have not been given an oral P2Y12 inhibitor beforehand and who are not receiving a glycoprotein IIb/IIIa inhibitor.
- Kengreal is given only in hospital, in the cardiac catheterisation laboratory, by the cardiology team; it is never self-administered and is not used at home.
- The identical cangrelor product is marketed in the European Union as Kengrexal, so the two brand names describe the same medicine.
- Its effect begins within minutes, and platelet function returns to normal about an hour after the infusion is stopped.
Side Effects
- Bleeding is the most common problem.
- In the CHAMPION PHOENIX trial any GUSTO bleeding occurred in 15.5% of people given Kengreal compared with 10.9% given clopidogrel; most events were mild bruising, oozing at the catheter site or nosebleeds, but severe or life-threatening bleeding can occur.
- Breathlessness is also common and usually settles quickly once the infusion ends.
- Serious hypersensitivity reactions, including anaphylaxis, bronchospasm and severe low blood pressure, have been reported, although they are rare - seven serious cases among 13,301 people studied.
- The Kengreal label carries no boxed warning.
- Tell the team straight away about black or bloody stools, pink or brown urine, coughing up blood, a severe headache, sudden weakness, chest tightness, wheezing or a rash, and report any puncture site that keeps bleeding.
Precautions & Warnings
- Kengreal must not be used in anyone with significant active bleeding or with known hypersensitivity to cangrelor or the vial contents.
- It is for intravenous use only: a 30 microgram/kg bolus followed immediately by a 4 microgram/kg per minute infusion, continued for at least two hours or for the length of the PCI, whichever is longer.
- Each 50 mg vial is reconstituted with 5 mL of sterile water and then diluted into 250 mL of saline or dextrose before use; it is never given undiluted, and never by any other route.
- The team will weigh up bleeding risk factors such as recent surgery, trauma, stroke, uncontrolled high blood pressure or a bleeding disorder.
- Platelet function recovers within about an hour of stopping, which matters if urgent surgery becomes necessary.
Avoid Interactions
- Effects that increase bleeding: other antiplatelet medicines, heparins and other anticoagulants, thrombolytic clot-busting drugs, NSAIDs such as ibuprofen or naproxen, and glycoprotein IIb/IIIa inhibitors, which are not given alongside Kengreal.
- Effects that reduce the benefit of the follow-on tablet: clopidogrel and prasugrel do not work if they are swallowed during a Kengreal infusion, because cangrelor occupies the receptor and blocks them.
- For that reason clopidogrel 600 mg or prasugrel 60 mg must be given immediately after the infusion is stopped, never during it.
- Ticagrelor 180 mg is not affected and may be given at any time during the infusion or immediately after.
- Tell the cardiology team about every medicine, herbal product and supplement you take, especially blood thinners.
- Do not mix Kengreal with other medicines in the same line.
References
Frequently Asked Questions
Kengreal (cangrelor) is an intravenous antiplatelet medicine used during percutaneous coronary intervention (PCI) to lower the risk of heart attack, repeat artery procedures and stent clots. It is for adults who have not already taken an oral P2Y12 inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor.
Kengreal (cangrelor) is given by the cardiology team in the catheterisation laboratory as a 30 microgram/kg injection into a vein, followed straight away by a drip of 4 micrograms/kg each minute. The drip runs for at least two hours, or until the PCI is finished, whichever is longer.
Bleeding is the main side effect of Kengreal (cangrelor); any bleeding occurred in 15.5% of patients versus 10.9% on clopidogrel. Breathlessness is also common. Tell staff at once about bloody stools or urine, coughing up blood, severe headache, sudden weakness, wheezing or rash, which can signal serious bleeding or allergy.
Avoid taking clopidogrel or prasugrel while the Kengreal (cangrelor) drip is running, because cangrelor blocks them and they will not work. Other blood thinners, clot-busting drugs, NSAIDs and glycoprotein IIb/IIIa inhibitors raise bleeding risk. Ticagrelor is the exception and may be given during the infusion.
Platelet function returns to normal within about an hour of stopping Kengreal (cangrelor), so an oral P2Y12 inhibitor is started to keep the stent protected. Clopidogrel 600 mg or prasugrel 60 mg is given immediately after the infusion ends; ticagrelor 180 mg may be given during it or after.
Yes. Kengreal and Kengrexal are the same medicine, cangrelor 50 mg per vial; Kengreal is the United States brand and Kengrexal the European one. Both are hospital-only intravenous antiplatelet drugs used during PCI, and neither is an anticoagulant despite sometimes being listed as one.
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