Cangrelor
Antiplatelet drugs
Antiplatelet drugs
An intravenous, reversible P2Y12 blocker that acts within minutes and wears off within an hour; used during PCI in patients not on an oral P2Y12 drug.
Quick facts
- Group
- Antiplatelet drugs
- Target
- P2Y12 ADP receptor on platelets
- Key effects
- Bleeding · Shortness of breath
- Monitor
- Bleeding at the arterial access site · Kidney function
- ATC
- B01AC25
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure with cangrelor is available; the figure shows the human P2Y12 receptor with 2-methylthio-ATP, a nucleotide in the pocket where cangrelor, whose structure is similar to ATP, is expected to bind.
Cangrelor, a molecule structurally similar to ATP, directly, reversibly and selectively blocks the platelet P2Y12 receptor, so ADP cannot activate platelets or make them aggregate. It needs no activation in the liver, works within minutes, and is quickly inactivated in the blood by dephosphorylation.
- ADP normally activates platelets through P2Y12
- Cangrelor blocks P2Y12 directly and reversibly
- Platelet aggregation stops within minutes
- When the infusion stops, function returns within an hour
Indications
- Adjunct during percutaneous coronary intervention to lower the risk of periprocedural myocardial infarction, repeat revascularisation and stent thrombosis, in patients not on an oral P2Y12 inhibitor or a GP IIb/IIIa inhibitor Myocardial Infarction (Heart Attack) →
Adverse effects
Common
- Bleeding (the most common effect)
- Shortness of breath (dyspnoea)
Contraindications
- Significant active bleeding
- Hypersensitivity to cangrelor
Key interactions
- Clopidogrel or prasugrel
- Have no antiplatelet effect if given during the infusion; they are given only after the infusion stops
- Ticagrelor
- Can be given during the infusion or right after it without losing its effect
- Anticoagulants and other antiplatelets
- Add to the bleeding risk
What is monitored
- Bleeding at the arterial access site and elsewhere
- Haemoglobin and vital signs
- Kidney function in severe renal impairment
Administration and safety
- Intravenous bolus followed by an infusion, started before PCI
- Its effect fades within an hour of stopping: the oral P2Y12 drug must be planned in time
- Clopidogrel or prasugrel only after the infusion ends; ticagrelor at any time
- Neuraxial anaesthesia is avoided during the infusion
Pregnancy and breastfeeding
There are no human data on birth defects; untreated myocardial infarction in pregnancy is dangerous, and cangrelor is stopped about one hour before labour or neuraxial anaesthesia when possible.
Nursing care
- Check the access site, vital signs and haemoglobin for bleeding
- Confirm the timing of the oral P2Y12 loading dose with the team
- Report breathlessness or allergic signs
- Hand over clearly when the infusion is stopped
Pharmacokinetics
- Absorption
- Intravenous bolus and infusion
- Metabolism
- Rapid dephosphorylation in the blood to an inactive nucleoside; independent of the liver
- Half-life
- About 3–6 minutes
- Onset and duration
- Platelet inhibition within 2 minutes; normal function within 1 hour of stopping
Test yourself
Think of the answer, then tap the question to see it.
Why are clopidogrel and prasugrel not given during a cangrelor infusion?
Cangrelor blocks P2Y12 and prevents their active metabolites from binding, so they have no effect.
How soon does platelet function recover after stopping cangrelor?
Within about 1 hour.
How is cangrelor inactivated?
By rapid dephosphorylation in the blood.
Connections
← Back to the class: Antiplatelet drugs
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CANGRELOR injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.