When should Cangrelor (antiplatelet medication) be stopped?

When to Stop Cangrelor

Cangrelor should be discontinued at least 1 hour before surgery or other procedures with bleeding risk, as its antiplatelet effect dissipates within 1 hour after discontinuation due to its short half-life. 1

Pharmacological Properties and Timing of Discontinuation

• Cangrelor is a direct-acting, intravenous P2Y12 receptor antagonist characterized by rapid onset and offset of action, with restoration of platelet function occurring within 1 hour of drug discontinuation 1, 2
• For patients requiring surgery or invasive procedures, cangrelor should be discontinued at least 1 hour prior to the procedure to minimize bleeding risk 2
• For patients undergoing labor, delivery, or neuraxial blockade, cangrelor should be discontinued at least 1 hour prior to minimize the risk of spinal hematoma 2

Transitioning Between Cangrelor and Oral P2Y12 Inhibitors

• When transitioning from cangrelor to oral P2Y12 inhibitors, timing is critical to ensure adequate platelet inhibition 1
• Clopidogrel or prasugrel administered during cangrelor infusion will have no antiplatelet effect until cangrelor is discontinued 2
• Oral P2Y12 inhibitors should be administered after cangrelor infusion is discontinued to ensure proper antiplatelet effect 2, 3

Special Clinical Scenarios

Bridging Strategy for Surgery

• For patients at high thrombotic risk requiring nondeferrable surgery, cangrelor can be used as a bridging strategy during perioperative withdrawal of dual antiplatelet therapy 4
• In bridging protocols, cangrelor infusion is typically discontinued 6-7 hours prior to surgical incision 4
• Cangrelor can be resumed approximately 9 hours following surgery if hemostasis is achieved and continued until oral antiplatelet therapy can be resumed 4

Patients Undergoing Coronary Artery Bypass Grafting (CABG)

• For patients requiring CABG within 1 month after stent implantation, a bridging strategy with cangrelor may be considered if both oral antiplatelet agents need to be discontinued perioperatively 1
• Cangrelor should be discontinued at least 1 hour before CABG to minimize bleeding risk 2

Monitoring and Safety Considerations

• Cangrelor has a favorable safety profile even in cases of overdosing, with rare bleeding complications due to its very short half-life and rapid offset of action 5
• In patients with severe renal impairment (creatinine clearance <30 mL/min), monitor for worsening renal function as this was reported more frequently with cangrelor (3.2%) compared to clopidogrel (1.4%) 2
• Monitor for hypersensitivity reactions including anaphylaxis, which occur more frequently with cangrelor than control treatments 2

Common Pitfalls to Avoid

• Administering oral P2Y12 inhibitors (clopidogrel or prasugrel) during cangrelor infusion, as they will have no antiplatelet effect until cangrelor is discontinued 2
• Delaying resumption of oral antiplatelet therapy after cangrelor discontinuation, which may lead to a gap in platelet inhibition 1
• Discontinuing cangrelor too early before procedures with high bleeding risk, or too late before procedures requiring normal platelet function 2

Cangrelor's unique pharmacological profile with rapid onset and offset of action makes it particularly valuable in clinical scenarios where oral P2Y12 inhibitors cannot be used or when rapid reversal of platelet inhibition may be needed 1, 6.