Kengreal (cangrelor) / Chiesi - LARVOL DELTA

End-Stage Achalasia Presenting as Megaesophagus and Bleeding Stasis Ulcers in a Patient on Dual Antiplatelet Therapy (ACG 2026) - "He was transitioned to IV cangrelor, and an orogastric tube was placed with significant output...Early treatment of achalasia is essential to prevent such complications, even when presenting symptoms may be mild. Figure: CT Abdomen Pelvis demonstrating markedly dilated and patulous distal esophagus with intraluminal fluid and debris and tapering at the level of the GE junction causing mass effect on the posterior margin of the heart Figure: Esophagogastroduodenoscopy (EGD) demonstrating marked dilation of the mid-esophagus with friable, ulcerated mucosa."

Clinical • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Myocardial Infarction • Rare Diseases • Thrombosis • Venous Ulcer

Cangrelor in elderly patients undergoing percutaneous coronary intervention: findings from the ICARUS Registry. (PubMed, J Cardiovasc Med (Hagerstown)) - "In this real-world study of patients undergoing PCI with cangrelor, elderly individuals accounted for one-third of the population. Elderly patients were at higher risk of NACE, driven by both ischemic and bleeding events."

Journal • Observational data • Retrospective data • Cardiovascular • Hematological Disorders • Myocardial Infarction • Thrombosis

CATCH-IT: Cangrelor As Treatment for Cardiac Surgery Associated With Heparin Induced Thrombocytopenia (clinicaltrials.gov) - P=N/A | N=132 | Not yet recruiting | Sponsor: Société Française d'Anesthésie et de Réanimation

New trial • Cardiovascular • Hematological Disorders • Thrombocytopenia

Redo Root and RVOT Reconstruction for Destructive Citrobacter Koseri Endocarditis. (PubMed, JACC Case Rep) - "Complex endocarditis with an aortocavitary fistula may require coordinated antiplatelet management, source control, and multicomponent reconstruction."

Journal • Cardiovascular • Infectious Disease

Clinical practice of cangrelor use in Austrian ACS patients: a real-world multicenter registry. (PubMed, Front Cardiovasc Med) - "Overall, 69% of patients received aspirin and heparin alone, whereas 31% also received an oral P2Y12 inhibitor before cangrelor initiation. Among patients transitioned to a thienopyridine, 9 (6%) received clopidogrel and 6 (4%) received prasugrel before cangrelor discontinuation. Major bleeding (BARC ≥3) occurred in 46 patients (7%), without observed differences according to the timing of oral P2Y12 inhibitor administration. This nationwide real-world study highlights considerable variability in the clinical use of Cangrelor and its integration with oral P2Y12 inhibitors."

Journal • Real-world evidence • Acute Coronary Syndrome • Cardiovascular

Rapid power, precise control: the evolving role of intravenous P2Y12 inhibition in chronic coronary syndromes, acute coronary syndromes, and cardiogenic shock (ESC 2026) - "Sponsored by Chiesi Farmaceutici SpA To analyse the pharmacological rationale in acute coronary syndromes: evaluate the impact of delayed oral P2Y12 absorption in STEMI and NSTE-ACS patients and assess how the rapid onset of intravenous inhibition mitigates peri-procedural thrombotic risk (transition schemes); To optimise outcomes in chronic coronary syndromes: identify high-risk clinical and anatomical subsets within the chronic coronary syndromes population that derive the greatest benefit from the reversible, precise platelet inhibition offered by cangrelor during elective PCI; and To navigate the critical care gap: evaluate the evidence for cangrelor as a feasible alternative to oral P2Y12 inhibitors in cardiogenic shock, focusing on its ability to bypass impaired gastrointestinal absorption and provide reliable platelet inhibition in haemodynamically unstable patients"

Acute Coronary Syndrome • Cardiovascular

Early bleeding risk prediction with the PRECISE-HBR score in PCI patients treated with cangrelor: the ICARUS registry (ESC 2026) - "Among patients undergoing PCI treated with cangrelor, the PRECISE-HBR score identified 41% of patients at HBR and showed modest ability in predicting early bleeding. The PRECISE-HBR score was associated with BARC 2-5 bleeding and NACE at 48 hours, which supports its role for early risk stratification in this setting."

Clinical • Cardiovascular

Infection drives excessive platelet inhibition during P2Y12 inhibitor therapy in coronary artery disease (ESC 2026) - "Under arterial shear, baseline thrombus formation was comparable (22% vs. 21%), yet 10 nM cangrelor reduced platelet surface coverage to 9% in infection versus 17% in controls, revealing a heightened sensitivity to P2Y12 inhibition under inflammatory conditions.We recruited a validation cohort comprising patients with established CAD receiving clopidogrel for P2Y12 inhibition. In infection, P2Y12 inhibitor therapy is frequently functionally overdosed. Infection represents a novel and clinically relevant determinant of P2Y12 inhibitor response."

Cardiovascular • Coronary Artery Disease • Thrombosis

Contemporary use and outcomes of temporary mechanical circulatory support in patients undergoing percutaneous coronary intervention (ESC 2026) - "In the catheterisation laboratory, cangrelor was administered in 56% of IABP cases, 64% of VA‑ECMO cases, and 32% of microaxial flow pump cases...VA‑ECMO was regularly used in cardiac arrest. Despite high overall mortality, outcomes among surviving patients discharged from CICU were favourable."

Clinical • Cardiovascular • Myocardial Infarction

A murine stable thrombosis model enabling therapeutic evaluation of antithrombotic drugs. (PubMed, Blood Vessel Thromb Hemost) - "Video microscopy revealed that 0.4 mg/mL cangrelor (P2Y12 inhibitor) or 4 mg/mL GR 144053 trihydrochloride (αIIbβ3 blocker) induced complete disaggregation, whereas 50 IU/mL heparin or 4 mg/mL recombinant tissue plasminogen activator induced destabilization of the thrombus. In contrast, 3.2 mg/mL aspirin, 40 IU/mL unfractionated heparin, or 4 mg/mL hirudin had no effect on a preformed thrombus. Altogether, this model constitutes a valuable platform for assessing therapeutic strategies aimed at stabilizing or dissolving established thrombi."

Journal • Preclinical • Cardiovascular • Hematological Disorders • Thrombosis

Contemporary Management of Acute Coronary Syndromes in the Cardiac Intensive Care Unit: From Rapid Diagnosis to Early Secondary Prevention. (PubMed, J Cardiovasc Dev Dis) - "Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet-anticoagulant treatment are selective strategies...High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care."

Journal • Review • Acute Coronary Syndrome • Cardiovascular • Critical care • Renal Disease

Injectable antiplatelet therapies in acute coronary syndromes: Current status and Emerging Therapies. A position paper of the Task Force of Antithrombotic therapy of the ACVC. (PubMed, Eur Heart J Acute Cardiovasc Care) - "Intravenous aspirin is used widely in patients with ACS, while the absorption of oral P2Y12 inhibitors is often delayed, and the intravenous P2Y12 inhibitor cangrelor can achieve almost complete platelet inhibition within minutes. While use of the glycoprotein IIb/IIIa inhibitors (GPI) eptifibatide and tirofiban is decreasing, typically reserved for thrombotic complications or no reflow following PCI, recently zalunfiban, a novel subcutaneously administered GPI has been shown to improve reperfusion before revascularisation in patients with STEMI when given at first medical contact. In this review, we dicuss the rationale and potential benefits of injectable antiplatelet medications, including currently available agents and those in development or being tested in clinical trials. While the benefit of injectable medications on hard clinical endpoints such as major adverse cardiac events remains unclear for an allcomers ACS population, there is emerging data that these..."

Journal • Acute Coronary Syndrome • Anesthesia • Cardiovascular • Myocardial Infarction

Navigating P2Y12 Resistance: Intraoperative Cangrelor Titration During High Risk Vascular Surgery (ASA 2026) - "The patient experienced no major neurologic or bleeding complications. This case highlights the potential role of titratable Cangrelor therapy in DAPT-resistant vascular patients."

Surgery • Cardiovascular • Hematological Disorders • Thrombosis

Heart Transplant in Patient with HIT, Anti-E and Anti-S Antibodies and Cold Agglutinins (ASA 2026) - "Warfarin was reversed with a heparin-sparing regimen of vitamin K and factor IX complex. CPB anticoagulation was maintained by protocolized cangrelor and heparin. The surgery proceeded uneventfully, with no major perioperative complications."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Transplantation

Acute RV Failure from RCA Dissection After Aortic and Tricuspid Valve Surgery (ASA 2026) - "Emergency coronary angiogram revealed 100% proximal RCA occlusion from iatrogenic dissection, treated with 3 overlapping DES and cangrelor. On POD1, worsening RV function required percutaneous RVAD placement. She was weaned from RVAD on POD7 and discharged home on POD24."

Surgery • Cardiovascular • Congestive Heart Failure • Heart Failure • Ventricular Tachycardia

Urgent Orthopedic Fixation Following Recent STEMI with Ongoing Cangrelor Infusion and Intra-Aortic Balloon Pump Support (ASA 2026) - "She remained on aspirin and cangrelor. Postoperatively, she required brief vasopressors, transitioned to clopidogrel, and was discharged on postoperative day five. This case highlights perioperative timing after recent PCI, antiplatelet management, and postoperative cardiac and surgical complications."

Cardiomyopathy • Cardiovascular • Musculoskeletal Diseases • Orthopedics

WHEN PLATELETS ARE PAUSED: ANESTHETIC CHALLENGES OF SPINAL DRAIN MANAGEMENT ON CANGRELOR, A CASE REPORT (ASA 2026) - "Following multidisciplinary discussion, Cangrelor was held 30 minutes pre-removal and resumed 60 minutes post-removal without neurologic sequelae. This case demonstrates that Cangrelor's ultrashort half-life (3-6 minutes) enables individualized neuraxial management when standard antiplatelet cessation is not feasible."

Case report • Clinical • Cardiovascular • Hematological Disorders • Thrombosis

From MAC to Mechanical Support: Anesthetic Management of Acute LMCA Occlusion During EP Ablation (ASA 2026) - "Cangrelor infusion was started to maintain stent patency...The patient was extubated and Impella removed on POD1 and discharged POD3. This case highlights rapid anesthetic escalation during catastrophic complications in EP procedures."

Cardiovascular • Hematological Disorders • Thrombosis

Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage. (PubMed, JACC Case Rep) - "When competing thrombotic and hemorrhagic risks fall outside guideline pathways, antithrombotic therapy can be reintroduced in reassessable steps, starting with short-acting agents, guided by serial neuroimaging."

Journal • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Myocardial Infarction • Thrombosis

Use of cangrelor in neuroendovascular interventions: real-world evidence from a single-center cohort. (PubMed, Neuroradiology) - "Although this study has an exploratory nature, cangrelor provided effective and safe peri-procedural platelet inhibition, ensuring high rates of stent patency and low rates of bleeding in both AIS and aneurysm-related populations requiring emergency stenting. Given the clinical heterogeneity between these cohorts, these preliminary observations should be interpreted separately and considered hypothesis-generating. Larger prospective studies are needed to confirm these findings."

HEOR • Journal • Real-world evidence • Cardiovascular • Hematological Disorders • Hypertension • Ischemic stroke • Vascular Neurology

Reperfusion Injury and Infarct Size: Why Translation has Been Difficult, and How We Move Forward. (PubMed, Curr Cardiol Rep) - "Although the PITRI trial showed reduced periprocedural platelet reactivity with cangrelor there was no reduction in infarct size or microvascular obstruction (MVO), exemplifying proximal target engagement without affecting imaging surrogates...The path forward is to align patient selection, phenotype-specific endpoints, and adaptive trial architecture, and to test mechanical interventions together with pharmacological adjuncts rather than in isolation. When these elements are aligned - as the SSO₂ programme arc suggests - cardioprotection in STEMI may yet deliver clinically meaningful benefit."

Journal • Review • Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Reperfusion Injury

Intravenous Cangrelor Versus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Endovascular Thrombectomy for Middle Cerebral Artery Stroke: A Multi-Institutional Propensity Score-Matched Analysis. (PubMed, AJNR Am J Neuroradiol) - "Both drugs demonstrated comparable outcomes overall. In an exploratory angioplasty/stenting subgroup, cangrelor was associated with reduced hemorrhagic complications but increased recurrent stroke, suggesting a complex risk-benefit tradeoff requiring individualized antiplatelet selection."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

Evaluation of the feasibility and safety of cangrelor in out-of-hospital cardiac arrest undergoing percutaneous coronary intervention. (PubMed, Acta Cardiol) - "Additionally, cangrelor was safe, with fewer overall bleeding events and no increase in major bleeding. These findings underscore the need for further investigation in larger, randomised trials."

Journal • Cardiovascular

Egyptian Society of Cardiology national advisory statement revisiting antiplatelet therapy: insights from E. S. C. 2025 hot-line trials. (PubMed, Egypt Heart J) - "The Egyptian Society of Cardiology supports a more individualized, risk-based approach to antiplatelet therapy, emphasizing ischemic-bleeding balance, stent technology, revascularization completeness, and national resource considerations. Recommendations should be interpreted cautiously given the preliminary nature of some ESC 2025 data."

Journal • Review • Cardiovascular

SOS1-RAS-RAF signaling sensitizes platelet responsiveness via GPVI and PAR-1 (ISTH 2026) - "At high convulxin and TRAP-6 concentrations, inhibition of SOS1-RAS interaction, (Bay-293), BRAF (PLX4032) or BRAF dimerization (PLX8394) partially reduced platelet αIIbβ3 integrin activation, P-selectin/CD63 surface expression, aggregation and phosphatidylserine exposure in a dose dependent manner...Synergistic inhibition of convulxin-induced platelet activation and MEK1/2 S217/221 phosphorylation was observed by combined blocking of BRAF and PKC isoforms (GF109203X), P2Y 12 receptor (AR-C69931), PI3K-p110β (TGX-221) and ASK1 (selonsertib), respectively...This project was supported by the German Research Foundation (DFG). DOI*10.1016/j.rpth.2026.105258"

ARAF • CD63 • MAP2K1