In short
Cangrelor is an intravenous antiplatelet medicine that blocks platelet activation and aggregation. It is being studied in a Phase 2 clinical trial for people with ischemic stroke who need emergency carotid artery stenting during clot removal. The trial includes 50 participants and is currently authorised to begin.
Key points
- Cangrelor is a direct P2Y12 platelet receptor inhibitor given intravenously.
- It is being tested in a Phase 2 trial for ischemic stroke with emergency carotid artery stenting.
- The trial plans to enrol 50 participants.
- The main measure is carotid artery stent patency 24 hours after stenting.
- The trial is currently authorised to start.
- Cangrelor is compared with clopidogrel and acetylsalicylic acid in the trial.
What is cangrelor?
Cangrelor is a direct P2Y12 platelet receptor inhibitor that blocks ADP-induced platelet activation and aggregation. It belongs to the class of medicines called platelet aggregation inhibitors. Other names for the same substance include cangrelor tetrasodium, AR-C69931XX, AR-C69931MX, ARL69931, and the trade name Kengreal. Cangrelor is authorised as a medicine, according to the registry records for the trial described on this page. The registry name for the substance is CANGRELOR, and in the trial it is the tested substance.
How does cangrelor work?
Cangrelor works by directly blocking the P2Y12 receptor on platelets. This receptor normally responds to ADP, a signal that makes platelets clump together. By blocking it, cangrelor reduces platelet activation and aggregation, which lowers the chance of unwanted blood clots forming. Unlike some other antiplatelet medicines, cangrelor is given intravenously, which allows the effect to start quickly and to be controlled during a procedure.
Which conditions is cangrelor used or studied for?
- Ischemic stroke with large artery occlusion — the trial studies cangrelor in people who have a blocked large artery in the front part of the brain and also a narrowed carotid artery in the neck that needs a stent during emergency clot removal.
- Coronary artery disease — earlier research has studied cangrelor in people with coronary artery disease, as reported in a meta-analysis of four randomised trials.
How is cangrelor given?
Cangrelor is given intravenously, according to the registry records for the trial. In the trial, the dose recorded for cangrelor is 1455 micrograms per kilogram given intravenously. The comparison medicines in the trial are clopidogrel, given orally at a dose of 300 milligrams, and acetylsalicylic acid, given orally or as an intravenous infusion at a dose of 500 milligrams.
What do the clinical trials show?
One registered clinical trial investigates cangrelor as the tested substance. The trial is a Phase 2 interventional study with a planned enrolment of 50 participants. It is currently authorised, meaning it has received approval to begin.
The trial includes people with acute ischemic stroke and a blocked large artery in the intracranial carotid artery or the first two segments of the middle cerebral artery. Participants must also have a symptomatic narrowing of at least 50% in the extracranial carotid artery that requires mechanical thrombectomy and emergency carotid artery stenting.
The main outcome measured in the trial is carotid artery stent patency at 24 hours after stenting, with a window of plus or minus 6 hours. The trial compares intravenous cangrelor with oral clopidogrel and acetylsalicylic acid.
What side effects are known?
Because cangrelor reduces platelet activity, the main concern is a higher risk of bleeding. In a meta-analysis of four randomised trials in people with coronary artery disease, researchers assessed major adverse cardiac events as the primary efficacy endpoint and major bleeding as a safety outcome. The available sources do not provide a detailed list of side effects from the stroke trial itself.