Summary

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• Kengreal (cangrelor) is indicated as an adjunct to percutaneous coronary intervention (PCI) for reducing the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.
• This summary is based on the review of seven systematic review(s)/meta-analysis(es). ^[1-7]
• Potent P2Y12 inhibitors, including cangrelor, prasugrel, and ticagrelor, significantly decreased the risk of composite adverse cardiovascular ischemic events compared to clopidogrel (95% CI 0.89-0.96, p < 0.001). Cangrelor specifically reduced the composite outcome of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours and 30 days, with no significant increase in major bleeding.
• Prasugrel and ticagrelor reduced cardiovascular mortality compared to clopidogrel (prasugrel OR 0.85, 95% CI 0.75-0.97; ticagrelor OR 0.82, 95% CI 0.73-0.93). Prasugrel reduced myocardial infarction (OR 0.75, 95% CI 0.63-0.89), and all three agents (prasugrel, ticagrelor, and cangrelor) reduced stent thrombosis.
• In patients with large-vessel-occlusion stroke, cangrelor combined with endovascular therapy resulted in 51.2% of patients achieving favorable outcomes (90-day mRS, 0-2) and 90.9% achieving successful reperfusion, with a symptomatic intracerebral hemorrhage rate of 9.5%.
• Potent P2Y12 inhibitors, including cangrelor, increased the risk of major bleeding (95% CI 1.15-1.33, p < 0.001) and any bleeding (95% CI 1.21-1.33, p < 0.001) compared to clopidogrel.
• Cangrelor was associated with higher risk of minor bleeding compared to clopidogrel or placebo, with a specific increase in TIMI minor bleeding (OR 1.47, 1.01-2.16) and GUSTO-defined mild bleeding (OR 1.28, 95% CI 1.09-1.50, p = 0.003). Symptomatic intracerebral hemorrhage was reported in 9.5% of patients with large-vessel-occlusion stroke treated with cangrelor, with a 90-day mortality rate of 24.4%.
• The evidence reviews multiple population types, including patients undergoing PCI, those with acute coronary syndromes, large-vessel occlusion stroke, and Type 2 Diabetes Mellitus. In T2DM patients, cangrelor demonstrated comparable efficacy to clopidogrel but was associated with higher risks of mild GUSTO and major and minor ACUITY bleeding.