Cangrelor is a Formulary Restricted medication.  Ordering restricted to cardiologist approval only, for patients who are:

• • Undergoing high-risk* PCI and unable to take oral antiplatelet medication and who have not been treated with an oral P2Y12 inhibitor. Once these patients have OG/NG tubes placed, oral antiplatelet medication may be administered and IV cangrelor must be discontinued;
  • or
  • Admitted with high-risk unstable coronary anatomy requiring urgent CABG. This includes patients transferred to Emanuel from other sites for CABG.
  • *High risk = high risk lesions, high thrombosis burden, challenging multiple stent PCI, high risk for stent thrombosis, no reflow or vein graft lesion.

Be mindful of appropriate timing for transition to oral P2Y12 inhibitors and note that clopidogrel and prasugrel are not effective if administered while cangrelor infusion is running: 

• • Conversion to clopidogrel: Administer 600 mg of clopidogrel immediately after discontinuing cangrelor infusion. Do not administer clopidogrel prior to cangrelor discontinuation.
  • Conversion to prasugrel: Administer 60 mg of prasugrel immediately after discontinuing cangrelor infusion. Do not administer prasugrel prior to cangrelor discontinuation.
  • Conversion to ticagrelor: Administer 180 mg of ticagrelor at any time during cangrelor infusion or immediately after discontinuing cangrelor infusion.

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