NICE has recommended ticagrelor (Brilique) in combination with low-dose aspirin for up to 12 months as a treatment option for adults with acute coronary syndromes (ACS), ie, STEMI, NSTEMI or unstable angina.
Ticagrelor inhibits platelet aggregation and thrombus formation by acting as a reversible antagonist of the P2Y12 adenosine diphosphate receptor.
Ticagrelor requires a loading dose of 180mg and is subsequently given at a dose of 90mg twice daily for up to 12 months. Patients should also be given a single loading dose of aspirin and continued on an aspirin dose of 75–150mg daily.
The double-blind, phase 3 PLATO study (n=18,624) compared ticagrelor with clopidogrel, both co-administered with aspirin, over a period of 12 months in patients hospitalised with ACS.
Ticagrelor was significantly more effective than clopidogrel in preventing vascular events in patients with ACS (event rates of 9.8% vs 11.7%; hazard ratio 0.84; 95% CI 0.75–0.95; p<0.001).
There was no significant difference in the rate of major bleeding between the two groups, although more patients taking ticagrelor withdrew from the study because of adverse effects.