Kengreal
Pronunciation: pronunciation varies by local usage.
- Generic name
- cangrelor
- Brand names
- KENGREAL
- Drug class
- P2Y12 platelet inhibitor
- Form
- For injection, for intravenous use
- Route
- Intravenous injection/infusion
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: United States
Australia: · Full directory
What cangrelor is and how it works
Cangrelor is an intravenous P2Y12 platelet inhibitor used as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction, repeat coronary revascularization, and stent thrombosis in patients who have not already received an oral P2Y12 inhibitor or a glycoprotein IIb/IIIa inhibitor. (1)
Cangrelor is given by intravenous bolus and infusion during PCI. Its rapid offset means the antiplatelet effect declines within about an hour after stopping, but there is no specific reversal agent.
Mechanism of action: how cangrelor works
Cangrelor is classified as a P2Y12 platelet inhibitor. After discontinuation, platelet function returns to normal within approximately 1 hour, and there is no specific reversal agent. (1)
What cangrelor is used for
Adjunct to percutaneous coronary intervention (PCI)
Cangrelor is indicated to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients undergoing PCI who have not been treated with a P2Y12 platelet inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor. (1)
Before taking cangrelor
Do not take / not appropriate for
- Cangrelor is not given to patients with active significant bleeding or known hypersensitivity to cangrelor. The healthcare team assesses this before administration; tell them about any bleeding problems or known drug allergies. (all use) (1)
Tell your clinician about
- If you have active significant bleeding or a known hypersensitivity to cangrelor.
- If you are pregnant or in labour/delivery, or breastfeeding (see special‑population notes for pregnancy and lactation).
- All current medications, especially clopidogrel, prasugrel, or ticagrelor, because cangrelor has specific interaction rules with these oral P2Y12 inhibitors.
How to take cangrelor
- Cangrelor is administered by the healthcare team as part of your PCI procedure.
- The dose and administration schedule are determined by the healthcare professional: a weight‑based intravenous bolus is given before PCI, followed immediately by a continuous weight‑based intravenous infusion for at least 2 hours or for the duration of the procedure, whichever is longer.
- Do not adjust the dose, infusion rate, or duration yourself. Any changes are managed by the clinical team.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
The infusion is managed by the healthcare team; do not attempt to restart or alter it yourself.
Overdose
Not established from the sources reviewed: a specific overdose-management protocol was not established in the sources reviewed for this page, beyond the fact that there is no specific reversal agent and that platelet function returns to normal within approximately 1 hour after the infusion is stopped. Contact the healthcare team promptly with any overdose concern. (1)
Side effects
The most common adverse reaction is bleeding. In the CHAMPION PHOENIX clinical trial, any GUSTO‑defined bleeding occurred in 15.5% of cangrelor‑treated patients versus 10.9% of clopidogrel‑treated patients. A detailed review of less‑common adverse events (e.g., dyspnea) was not performed in this research pass and remains an unresolved gap.
Bleeding
What to notice: Bleeding occurs more often with cangrelor than with clopidogrel: in the CHAMPION PHOENIX trial, any GUSTO-defined bleeding occurred in 15.5% of cangrelor-treated patients versus 10.9% of clopidogrel-treated patients.
What to do: Tell the healthcare team immediately about any unexpected bleeding, bruising, or other concerning symptoms. The clinical team will assess and manage the situation. (1)
Serious or life‑threatening bleeding
What to do: Emergency medical attention is required for any sign of serious bleeding. The healthcare team will assess and decide on management. (1)
Serious warnings
Bleeding — emergency
Symptoms: Uncontrolled or excessive bleeding. Bleeding occurred more often with cangrelor than with clopidogrel in clinical trials (15.5% vs 10.9%, any GUSTO-defined bleeding).
Action: Seek emergency medical attention for any sign of serious bleeding; the healthcare team will evaluate and decide on management. There is no specific reversal agent, but the antiplatelet effect declines rapidly (within about 1 hour) once the infusion is discontinued. (1)
Hypersensitivity reactions — emergency
Symptoms: Known hypersensitivity to cangrelor is listed as a reason not to receive it.
Action: Seek emergency medical attention immediately for any signs of a severe allergic reaction; the healthcare team will manage the infusion and treatment. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Clopidogrel or prasugrel (thienopyridine P2Y12 inhibitors) | These oral antiplatelet drugs are rendered ineffective if administered during the cangrelor infusion because their active metabolite cannot bind to the P2Y12 receptor. | Clopidogrel and prasugrel are not given during the cangrelor infusion, because they would have no antiplatelet effect until the infusion is discontinued. The prescribing clinician or healthcare team decides the appropriate timing of the first oral dose after the infusion ends. (1) |
| Ticagrelor (oral P2Y12 inhibitor) | Ticagrelor can be administered during the cangrelor infusion without a clinically significant interaction. | Ticagrelor may be given concurrently if clinically indicated, as it can provide antiplatelet effect before the cangrelor infusion is stopped. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Renal impairment
No dosage adjustment is needed for patients with any degree of renal impairment. (1)
Hepatic impairment
No dosage adjustment is required for patients with hepatic impairment. (1)
Geriatric patients
In clinical trials, 18% of patients were 75 years of age or older, and cangrelor is described as considered safe in this age group. (1)
Pregnancy and labour/delivery
Cangrelor should be avoided during labour and delivery. Neuraxial blockade (e.g., epidural or spinal anaesthesia) is contraindicated in patients receiving cangrelor because of the risk of bleeding. (1)
Lactation
Discuss breastfeeding with the treating physician before use. (1)
Monitoring
Before starting
- Confirm the indication, the patient's PCI plan, and the absence of active significant bleeding or hypersensitivity to cangrelor.
During treatment
- Monitor closely for signs of bleeding.
- Observe for hypersensitivity reactions.
- After the infusion is stopped, ensure timely transition to an oral P2Y12 inhibitor, observing the interaction rules (clopidogrel or prasugrel only after the infusion ends; ticagrelor may be given concurrently).
Storage
Specific storage, reconstitution, and stability instructions were not reviewed in this research pass and remain unresolved. Refer to the official prescribing information and hospital pharmacy guidelines for storage conditions of the lyophilized powder and reconstituted solution.
Study the drug class: Antiplatelet agents
Professional information
Clinician‑facing context only. Always consult the current official prescribing information and applicable institutional protocols before administration.
United States
Indication: Adjunct to PCI
Dose summary: 30 mcg/kg intravenous bolus administered rapidly (under 1 minute) before PCI, immediately followed by a 4 mcg/kg/min continuous intravenous infusion for at least 2 hours or for the duration of the procedure, whichever is longer. Transition to an oral P2Y12 inhibitor after the infusion ends, with attention to the interaction profile (clopidogrel/prasugrel only after discontinuation; ticagrelor may be given concurrently).
Renal context: No dose adjustment needed for renal impairment. (1)
Hepatic guidance
No dosage adjustment required in hepatic impairment per FDA labeling.
Overdose note
Not established from the sources reviewed: a specific overdose-management protocol was not established in the sources reviewed for this page, beyond the absence of a specific reversal agent and the rapid offset of effect (platelet function returns to normal within approximately 1 hour after stopping the infusion). (1)
Frequently asked questions
Can cangrelor be used outside the PCI setting?
In the United States, cangrelor's reviewed indication is as an adjunct during percutaneous coronary intervention (PCI) in patients not already treated with a P2Y12 platelet inhibitor and not receiving a glycoprotein IIb/IIIa inhibitor. (1)
How quickly does the antiplatelet effect reverse after stopping cangrelor?
Platelet function returns to normal within approximately 1 hour after the infusion is stopped. (1)
Can I receive clopidogrel or prasugrel while on cangrelor?
No. Clopidogrel and prasugrel should not be given during the cangrelor infusion because they will be ineffective. These medications are usually given only after the cangrelor infusion has been stopped. Ticagrelor, however, can be given at the same time. (1)
What should I do if I have bleeding during or after the cangrelor infusion?
Tell the healthcare team immediately. There is no specific antidote, but the antiplatelet effect wears off quickly (within about 1 hour of stopping the infusion). Not established from the sources reviewed: specific management steps beyond this were not established in the sources reviewed for this page. (1)
What is the mechanism of action of cangrelor?
Cangrelor is classified as a P2Y12 platelet inhibitor. After discontinuation, platelet function returns to normal within approximately 1 hour, and there is no specific reversal agent. (1)
What is the generic name of Kengreal?
The generic name is cangrelor. It is sold under brand names including KENGREAL. (1)
What class of drug is cangrelor?
Kengreal is classed as: P2Y12 platelet inhibitor. (1)
References
- KENGREAL (cangrelor) for injection, for intravenous use — prescribing informationU.S. Food and Drug Administration · United States · dated 2026-08-05 · accessed 2026-08-05 · source 1
- KENGREAL (CANGRELOR) INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION [CHIESI USA, INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- KENGREAL — FDA approval record (Drugs@FDA NDA204958)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 3
- cangrelor — RxNorm normalized drug concept (RXCUI 1656052)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 4
Brand names by country
Single-ingredient cangrelor names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- KENGREAL50 mg · chiesi usa, inc.