This page shows what was measured, who it was measured in, and what that does not settle.
What Cangrelor does in the body
Preventing clots during a stent procedure in someone who has not already taken a platelet tablet
Platelets recruit each other using a chemical called ADP. Cangrelor is a modified version of ATP, a molecule your cells already use, redesigned so that it sits in the ADP receptor and blocks it without being broken down by the enzymes that would normally destroy it. Because it goes straight into a vein and needs no conversion, blockade is essentially complete within two minutes. Because it is cleared by enzymes in the blood rather than by the liver or kidneys, it disappears with a half-life of a few minutes and platelet function is back to normal about an hour after the drip stops.
What happened in people
Primary composite 4.7% against 5.9% in 11,145 patients, with death 18 events in each arm and myocardial infarction 202 against 254
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
The only P2Y12 inhibitor that can be started and stopped within the timescale of a single procedure
Where it acts
The surface membrane of circulating platelets, throughout the duration of the coronary procedure
Kind of result
Living longer, or avoiding a major event
Supervision
RNAWiki has not recorded a supervision or regulatory status for this substance.
What the registries record it as
The substance registry classes this as chemical.
FDA substance registry · 6AQ1Y404U7 · read 2026-08-29
Where each sentence above came from
No recorded sentence describes the change this makes in a way that stands on its own. The page opens with what it is taken for instead, and the recorded explanation follows below.
Shown as the opening line on this page.
A limit recorded against this substance. Not signed off as a reviewed claim.
The four opening statements run to 145 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Absolute difference
An absolute difference is how many more people in a hundred were affected.
A picture of it, and where the picture fails
It is like counting heads in two rooms of a hundred.
Where that stops being true. Heads are easy to count. Study results carry a margin of error too.
What people get wrong. It is confused with a percentage change, which can look far larger.
The arithmetic difference in event rates between arms.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Composite of death from any cause, myocardial infarction or ischaemia-driven revascularisation at 48 hours, cangrelor versus 600 mg clopidogrel before intervention
Composite of death, myocardial infarction or ischaemia-driven revascularisation at 48 hours, cangrelor versus placebo at the time of intervention
✗ The study did not show it
Who was studied
CHAMPION PLATFORM (NCT00385138)
How many people
5362
Study design
Phase 3 randomised double-blind placebo-controlled trial, stopped early for futility
Compared against
A dummy treatment
Kind of result
Living longer, or avoiding a major event
What was found
7.0% (185/2654) vs 8.0% (210/2641), odds ratio 0.87 (95% CI 0.71 to 1.07), p=0.17
Repeated elsewhere
Failed to Replicate
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. Enrolment stopped after an interim analysis concluded superiority was unlikely. Two prespecified secondary endpoints reached significance in a futility-stopped trial — stent thrombosis 0.2% vs 0.6% and death 0.2% vs 0.7%, both p=0.02 — which is hypothesis-generating. Major bleeding on one scale rose from 3.5% to 5.5% (p<0.001) from groin haematomas.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravenous bolus followed by continuous infusion, catheter laboratory use only
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Composite of death, myocardial infarction, ischaemia-driven revascularisation or stent thrombosis at 48 hours, cangrelor versus 300 or 600 mg clopidogrel
4.7% vs 5.9%, adjusted odds ratio 0.78 (95% CI 0.66 to 0.93), p=0.005. Stent thrombosis 0.8% vs 1.4%, odds ratio 0.62, p=0.01
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The FDA label states that most of the effect was post-procedural myocardial infarction detected solely by CK-MB elevation, and that death was not reduced — 18 events in each arm. Patients already on an oral P2Y12 inhibitor and those receiving glycoprotein IIb/IIIa inhibitors were excluded. Transient dyspnoea 1.2% vs 0.3%.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravenous bolus followed by continuous infusion, catheter laboratory use only
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Platelet reactivity in P2Y12 reaction units, assessed daily, in thienopyridine-treated patients bridged to bypass surgery
✓ The study showed what it set out to show
Who was studied
BRIDGE (NCT00767507)
How many people
210
Study design
Phase 2 randomised double-blind placebo-controlled trial with a dose-finding lead-in
Compared against
A dummy treatment
Kind of result
A number that stands in for health
What was found
P2Y12 reaction units below 240 throughout treatment in 98.8% (83/84) vs 19.0% (16/84), relative risk 5.2 (95% CI 3.3 to 8.1), p<0.001
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The endpoint was a laboratory measurement, not a clinical outcome, and the trial was not powered for ischaemic events. Excessive surgery-related bleeding 11.8% vs 10.4% (p=0.763), with numerically more minor bleeding on cangrelor. Bridging is not a United States approved indication.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Intravenous bolus followed by continuous infusion, catheter laboratory use only
Interval reported. 95% CI 3
Written into the record, not signed off as a reviewed claim.
RNAWiki holds 4 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Cangrelor
What a person takes: Intravenous bolus followed by continuous infusion, catheter laboratory use only.
The measurement behind this step
Reconstituted from a lyophilised powder and given as a weight-based bolus followed by an infusion for the duration of the procedure, typically 2 to 4 hours. Because it occupies the receptor that clopidogrel and prasugrel must bind covalently, an oral thienopyridine given during the infusion is wasted — in the pivotal trial clopidogrel was administered immediately at the end of the infusion, not before it. Ticagrelor, binding reversibly at a different site, is not affected in the same way.
Getting in
Straight into a vein, working before the needle is out
Given as an intravenous push followed by a drip. Platelet blockade is essentially complete within two minutes, with no waiting for absorption or liver conversion.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
A bolus of 30 micrograms per kilogram followed by an infusion of 4 micrograms per kilogram per minute for 2 to 4 hours in the pivotal trial. Cangrelor is pharmacologically active as administered, requires no cytochrome P450 step, and achieves near-complete P2Y12 blockade within 2 minutes.
A copy of a molecule your cells already use, made indestructible
It is built from ATP, the energy molecule in every cell, with one chemical link swapped so that blood enzymes cannot chew it up in seconds.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
An ATP analogue with thioether substitutions at the purine 2 and 6 positions and, critically, a dichloromethylene bridge replacing the oxygen between the beta and gamma phosphates. Without that bridge the ectonucleotidases in plasma would degrade the triphosphate chain almost instantly; with it, the half-life is 3 to 6 minutes rather than seconds.
It sits in the receptor platelets use to hear each other and blocks it. No conversion, no enzyme, no waiting.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Direct reversible antagonism at P2Y12 with high affinity. Because occupancy is concentration-driven and reversible, the degree of inhibition tracks the infusion rate rather than accumulating over doses, which is why the effect is titratable in a way no oral agent in the class is.
Plasma enzymes take it apart, not the liver or kidneys
It is broken down by enzymes in the blood itself, so it disappears at the same rate whether or not your organs are working.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Degradation is by dephosphorylation in the circulation, independent of hepatic metabolism and renal excretion. Platelet function returns to normal within about an hour of stopping the infusion, and no dose adjustment is required for hepatic or renal impairment — a property no oral P2Y12 inhibitor shares.
Fewer enzyme-defined infarcts, and the same number of deaths
The composite endpoint fell by about a fifth. The label says most of that was heart attacks detected only by a blood test, and that deaths were not reduced.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
CHAMPION PHOENIX: primary composite 4.7% against 5.9% (adjusted odds ratio 0.78, p=0.005), stent thrombosis 0.8% against 1.4%, severe bleeding 0.16% against 0.11%. Component table: death 18 against 18, myocardial infarction 202 against 254, revascularisation 10 against 14, stent thrombosis 27 against 36. Transient dyspnoea occurred in 1.2% against 0.3%, the same adenosine-related effect seen with ticagrelor.
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 5 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Patients undergoing coronary intervention who have not already taken an oral P2Y12 inhibitor — someone arriving unconscious, intubated, vomiting, or going straight from the door to the catheter laboratory.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “Safety and effectiveness in pediatric patients have not been established.”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
On older people, the label states: “In CHAMPION PHOENIX, 18% of patients were ≥75 years.”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
On people who are pregnant, the label states: “Risk Summary There are no available data on cangrelor use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes.”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary There are no data on the presence of cangrelor in human milk or animal milk, the effects on the breastfed infant, or the effects on milk production.”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
On people with reduced liver function, the label states: “Cangrelor has not been studied in patients with hepatic impairment.”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
On people with reduced kidney function, the label states: “No dosage adjustment is required for patients with mild, moderate, or severe renal impairment [see Clinical Pharmacology (12.3) ].”
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
Where the result stopped carrying
CHAMPION PCI, not superior to clopidogrel at 48 hours or at 30 days, with ACUITY major bleeding trending higher
CHAMPION PLATFORM, stopped early for futility against placebo
The death component of CHAMPION PHOENIX, identical at 18 events in each arm
The pre-surgical bridging indication, tested on a platelet-function endpoint and never approved in the United States
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
There was nothing to correct
Where a level is already normal, topping it up may change nothing.
On this record: The only P2Y12 inhibitor that can be started and stopped within the timescale of a single procedure
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (10)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Given by a clinician
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Intravenous bolus followed by continuous infusion, catheter laboratory use only
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
Reconstituted from a lyophilised powder and given as a weight-based bolus followed by an infusion for the duration of the procedure, typically 2 to 4 hours.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold. The rest of the recorded wording: Because it occupies the receptor that clopidogrel and prasugrel must bind covalently, an oral thienopyridine given during the infusion is wasted — in the pivotal trial clopidogrel was administered immediately at the end of the infusion, not before it. Ticagrelor, binding reversibly at a different site, is not affected in the same way.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Bleeding is the principal risk and was not significantly increased over clopidogrel in the pivotal trial (severe bleeding 0.16% against 0.11%), though an earlier trial recorded more groin haematomas against placebo. Transient dyspnoea occurred in 1.2% against 0.3% on clopidogrel — the same adenosine-related effect seen with ticagrelor, to which cangrelor is chemically related. Hypersensitivity reactions including anaphylaxis have been reported. No dose adjustment is required for hepatic or renal impairment, because clearance is by plasma dephosphorylation. There is no reversal agent and none is needed: platelet function recovers within about an hour of stopping the infusion.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Intravenous bolus followed by continuous infusion, catheter laboratory use only
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
A recorded note compares this form with the others that are sold. It is kept below, word for word.
§ A fixed RNAWiki sentence
Where this came from
Wording RNAWiki always uses, not a finding about this substance.
The recorded note, unchanged: Because it occupies the receptor that clopidogrel and prasugrel must bind covalently, an oral thienopyridine given during the infusion is wasted — in the pivotal trial clopidogrel was administered immediately at the end of the infusion, not before it. Ticagrelor, binding reversibly at a different site, is not affected in the same way.
No source is stored against this line.
What is recorded as being sold
5 products list this as an active ingredient in the United States drug directory. 5 of them contain it and nothing else.
FDA National Drug Code directory · 73301-003 · read 2026-08-29
They are sold as injection, powder, lyophilized, for solution and powder, taken intravenous.
FDA National Drug Code directory · 73301-003 · read 2026-08-29
The regulator's established pharmacologic class for it is decreased platelet aggregation [pe], p2y12 platelet inhibitor [epc] and p2y12 receptor antagonists [moa].
FDA National Drug Code directory · 73301-003 · read 2026-08-29
2 published labels name it as an active ingredient. 2 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-29
Cangrelor is intravenous at 3 DOSAGE FORMS AND STRENGTHS For Injection: 50 mg of Cangrelor for injection lyophilized powder in a single-dose 10 mL glass vial for reconstitution., recorded as fda label in effect 2025-08-14 in the United States.
US prescribing information · c86264c2-ef49-4524-b6af-edb7a6279faa · read 2026-08-30
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of Cangrelor studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That the composite reduction in CHAMPION PHOENIX represents prevented clinical heart attacks — the label attributes most of it to CK-MB-defined type 4a infarction and records no reduction in death
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the mortality and stent thrombosis signals in CHAMPION PLATFORM are real — they are secondary endpoints in a trial stopped for futility
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That cangrelor is superior to the faster oral agents or to the intravenous glycoprotein IIb/IIIa inhibitors — it has never been compared with either
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That maintaining a platelet-reactivity value before surgery prevents clinical events — BRIDGE measured a laboratory endpoint and the indication was never approved
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Cangrelor are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
CHAMPION PCI: not superior to a clopidogrel tablet in 8,877 patients
In plain words
The first large trial compared cangrelor with a single high dose of clopidogrel given before the procedure. There was no difference at 48 hours or at 30 days.
What was measured
Composite of death, myocardial infarction or ischaemia-driven revascularisation at 48 hours, 7.5% against 7.1%
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
CHAMPION PCI (NCT00305162) randomised 8,877 patients with acute coronary syndromes, of whom 8,716 underwent intervention, to cangrelor given 30 minutes before the procedure and continued for 2 hours after, or to 600 mg of oral clopidogrel 30 minutes before. The primary composite of death from any cause, myocardial infarction or ischaemia-driven revascularisation at 48 hours occurred in 7.5% on cangrelor against 7.1% on clopidogrel — odds ratio 1.05 (95% CI 0.88 to 1.24), p=0.59. Cangrelor was not superior at 30 days either. Major bleeding by ACUITY criteria was higher on cangrelor at 3.6% against 2.9%, odds ratio 1.26 (95% CI 0.99 to 1.60), p=0.06, though TIMI and GUSTO bleeding did not differ. A secondary exploratory endpoint restricted to death, Q-wave myocardial infarction or revascularisation trended in cangrelor’s favour at 0.6% against 0.9% but was not significant (p=0.14).
Written into the record, not signed off as a reviewed claim
CHAMPION PLATFORM: stopped early for futility against placebo
In plain words
The second trial compared cangrelor with placebo and was halted when an interim analysis concluded it was unlikely to succeed. It did not.
What was measured
Composite of death, myocardial infarction or ischaemia-driven revascularisation at 48 hours, 7.0% against 8.0% on placebo, p=0.17
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
CHAMPION PLATFORM (NCT00385138) randomised 5,362 clopidogrel-naive patients to cangrelor or placebo at the time of intervention, both followed by 600 mg of clopidogrel. Enrolment was stopped when an interim analysis concluded the trial would be unlikely to show superiority. The primary composite of death, myocardial infarction or ischaemia-driven revascularisation at 48 hours occurred in 185 of 2,654 cangrelor patients (7.0%) against 210 of 2,641 placebo patients (8.0%) — odds ratio 0.87 (95% CI 0.71 to 1.07), p=0.17. Two prespecified secondary endpoints were significantly reduced: stent thrombosis from 0.6% to 0.2% (odds ratio 0.31, p=0.02) and death from any cause from 0.7% to 0.2% (odds ratio 0.33, p=0.02). Major bleeding on one scale rose from 3.5% to 5.5% (p<0.001), attributed to groin haematomas, with no significant difference in transfusion. Secondary endpoints in a trial stopped for futility are hypothesis-generating, and the authors said as much: further study "may be warranted".
Written into the record, not signed off as a reviewed claim
CHAMPION PHOENIX succeeded, and the FDA label says the effect was enzyme-defined infarcts
In plain words
The third trial met its target. The American label states plainly that most of the benefit was a reduction in heart attacks detected only by a blood enzyme rise after the procedure, and that the drug did not reduce death.
What was measured
Primary composite 4.7% against 5.9%, with death 18 events against 18 and myocardial infarction 202 against 254
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
CHAMPION PHOENIX (NCT01156571) randomised 11,145 patients undergoing urgent or elective intervention, none previously treated with an oral P2Y12 inhibitor and none receiving a glycoprotein IIb/IIIa inhibitor, to cangrelor or to 300 or 600 mg of clopidogrel. The primary composite of death, myocardial infarction, ischaemia-driven revascularisation or stent thrombosis at 48 hours occurred in 4.7% against 5.9%, adjusted odds ratio 0.78 (95% CI 0.66 to 0.93), p=0.005. Severe bleeding was 0.16% against 0.11% (p=0.44) and stent thrombosis 0.8% against 1.4% (odds ratio 0.62, p=0.01). The label’s own account of what moved is unambiguous: "Most of the effect was a reduction in post-procedural MIs detected solely by elevations in CK-MB (type 4a MI). KENGREAL did not reduce the risk of death." Its component table gives death as 18 events (0.3%) in each arm, myocardial infarction 202 (3.7%) against 254 (4.6%), revascularisation 10 against 14, stent thrombosis 27 against 36. A supplementary analysis omitting intraprocedural stent thrombosis and the smallest enzyme rises reduces the event counts to 79 (1.4%) against 114 (2.1%), odds ratio 0.69 (95% CI 0.52 to 0.92) — the same direction on a quarter of the events, which is reassuring about the direction and does not restore the deaths.
Written into the record, not signed off as a reviewed claim
Three trials, one positive, and the comparator was always the slowest tablet
In plain words
Every trial compared cangrelor with clopidogrel, the slowest of the oral platelet drugs. It has never been compared with the fast ones, or with the intravenous drugs that fill the same gap.
What was measured
That cangrelor is the best option for the procedural window — it has only ever been compared with clopidogrel, and never with the faster oral agents or with the intravenous glycoprotein IIb/IIIa inhibitors
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
CHAMPION PCI, PLATFORM and PHOENIX all used clopidogrel as the active comparator — a drug requiring two cytochrome P450 conversions and hours to reach full effect, and one that a substantial minority of patients convert poorly. Ticagrelor and prasugrel both act far faster, and neither has ever been compared with cangrelor in a randomised trial. Nor have the intravenous glycoprotein IIb/IIIa inhibitors, which address the same procedural window by blocking the final common receptor: patients receiving or scheduled to receive one were excluded from CHAMPION PHOENIX, and the label’s indication is restricted accordingly to patients "not being given a glycoprotein IIb/IIIa inhibitor". The comparison that established this drug is therefore against the weakest available alternative, and its licensed population is defined by the exclusions of its pivotal trial rather than by a demonstrated advantage over the drugs it competes with.
Source
KENGREAL United States prescribing information, sections 1 and 14.1; Harrington RA et al., N Engl J Med 2009;361:2318-2329; Bhatt DL et al., N Engl J Med 2013;368:1303-1313
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
The bridging trial measured a platelet test, and that indication was never approved
In plain words
A trial tested cangrelor as a bridge for patients coming off tablets before heart surgery. Its main measure was a laboratory platelet test, not any clinical outcome, and the use is not on the American label.
What was measured
Proportion maintaining P2Y12 reaction units below 240 throughout treatment, 98.8% against 19.0%
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
BRIDGE (NCT00767507) randomised 210 patients with an acute coronary syndrome or a coronary stent, on a thienopyridine and awaiting bypass surgery, to cangrelor or placebo after their oral drug was stopped, for at least 48 hours and until 1 to 6 hours before surgery. The primary efficacy endpoint was platelet reactivity in P2Y12 reaction units, assessed daily: 98.8% of cangrelor patients (83 of 84) maintained a value below 240 throughout, against 19.0% on placebo (16 of 84), relative risk 5.2 (95% CI 3.3 to 8.1), p<0.001. Excessive surgery-related bleeding was 11.8% against 10.4% (relative risk 1.1, p=0.763). What the trial demonstrated is exactly what its conclusion claims — "a higher rate of maintenance of platelet inhibition" — and nothing about ischaemic events, because it was not designed or powered for them. Bridging is not among the indications on the United States label, which covers percutaneous coronary intervention only.
Written into the record, not signed off as a reviewed claim
On in two minutes, off in an hour, regardless of kidneys or liver
In plain words
Blockade is essentially complete two minutes after the injection and platelet function is back to normal about an hour after the drip stops — the same in someone with kidney or liver failure as in anyone else.
What was measured
Onset of near-complete platelet inhibition within 2 minutes, plasma half-life 3 to 6 minutes, recovery within approximately 1 hour, independent of hepatic and renal function
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Cangrelor requires no metabolic activation and is degraded by dephosphorylation in the plasma itself, giving a half-life of 3 to 6 minutes and full recovery of platelet function within about an hour of stopping the infusion. Because degradation is by circulating enzymes rather than hepatic metabolism or renal excretion, clearance does not change with organ failure. This is a genuine and unusual pharmacological property, and it is what the drug is actually for: it is the only P2Y12 inhibitor whose effect can be started and stopped inside the timescale of a procedure. The measured onset and offset are not in dispute. What the trials did not establish is that this property produces fewer deaths — the pivotal trial recorded 18 deaths in each arm.
Source
KENGREAL United States prescribing information, section 12 Clinical Pharmacology; Bhatt DL et al., N Engl J Med 2013;368:1303-1313
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
It blocks the receptor the oral thienopyridines need to bind to
In plain words
Give clopidogrel or prasugrel while the drip is running and they do not work, because cangrelor is sitting on the receptor they have to attach themselves to permanently.
What was measured
Loss of thienopyridine effect when the active metabolite is present during cangrelor infusion, addressed in the pivotal trial by dosing clopidogrel at the end of the infusion
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Clopidogrel and prasugrel act through active metabolites that form a covalent disulphide bond with P2Y12. Cangrelor occupies the same receptor reversibly and at high concentration, so a thienopyridine active metabolite arriving during the infusion has nowhere to bind and is cleared before the receptor becomes free. The consequence is written into the trial design and the label: in CHAMPION PHOENIX, patients randomised to cangrelor received their 600 mg of clopidogrel immediately at the end of the infusion rather than during it. Ticagrelor, which binds reversibly at a different site, does not have this problem. This is a pharmacological interaction between two drugs at the same receptor, it was measured rather than assumed, and it is the kind of detail that determines whether a treatment sequence works or silently does nothing.
Source
KENGREAL United States prescribing information, section 14.1 and drug interactions; Bhatt DL et al., N Engl J Med 2013;368:1303-1313
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
How many documents were read
2 documents were read for this substance.
RNAWiki source record
2 of them state the same proteinBinding, and they agree.
RNAWiki source record
2 of them state the same volumeOfDistribution, and they agree.
RNAWiki source record
Where else this substance is registered
FDA substance identifier (UNII)
6AQ1Y404U7
RxNorm concept
1656056
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3 approved applications cover products containing this substance. The earliest was NDA204958, approved 20150622 to CHIESI.
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An intravenous platelet blocker that works within two minutes and wears off within an hour, which missed its primary endpoint in two consecutive trials totalling 14,239 patients before meeting it in a third — where, in the FDA’s own words on the label, "most of the effect was a reduction in post-procedural MIs detected solely by elevations in CK-MB" and death was 18 events in each arm.
Recorded evidence blocks (7)
Q1
On the Cangrelor label: indicated for what?
"KENGREAL is indicated as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with a P2Y 12 platelet inhibitor and are not being given a glycoprotein…": indications and usage on Cangrelor's label. DailyMed label · 88b434fa-8891-4fd5-9d86-7ea64667c08f · 2025-10-21
Q2
30 registered trials of Cangrelor — at which phases?
ChEMBL 37 — CC BY-SA 3.0 Unported · ClinicalTrials.gov — US Government work · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
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