What is the indication for Brilinta (Ticagrelor)?

From the Guidelines

Brilinta (ticagrelor) should be prescribed at a dose of 90 mg twice daily for patients with acute coronary syndrome, in combination with aspirin (usually 81 mg daily), as this combination has been shown to be effective in preventing blood clots and reducing the risk of heart attack, stroke, and death 1. The use of Brilinta is supported by recent guidelines, which recommend its use over clopidogrel for maintenance P2Y12 inhibitor therapy in patients with ACS treated with DAPT after coronary stent implantation, due to its more rapid and consistent onset of action and faster recovery of platelet function 1. Some key points to consider when prescribing Brilinta include:

• The standard dosing is typically 90 mg twice daily for the first year after a cardiac event, followed by 60 mg twice daily for long-term therapy.
• Patients should take Brilinta with aspirin (usually 81 mg daily), as this combination more effectively prevents blood clots than either medication alone.
• Common side effects include bleeding, shortness of breath, and headache.
• Patients should not stop taking Brilinta without consulting their doctor, as premature discontinuation increases the risk of heart attack, stroke, and death.
• Brilinta works by blocking P2Y12 receptors on platelets, preventing them from clumping together to form clots.
• Unlike clopidogrel (Plavix), Brilinta doesn't require metabolic activation, making it more consistent in its effects across patients.
• Those taking Brilinta should inform all healthcare providers about this medication before any procedures due to increased bleeding risk, and should avoid grapefruit products as they can increase blood levels of the drug. It's also important to note that the benefit of ticagrelor over clopidogrel was limited to patients taking 75 mg to 100 mg of aspirin, and that the short half-life of ticagrelor requires twice-daily administration, which could potentially result in adverse events in non-compliant patients, particularly after stent implantation 1. In addition, when possible, ticagrelor should be discontinued at least 5 days before surgery, and its use in aspirin-intolerant patients is a reasonable alternative 1. Overall, the use of Brilinta in patients with acute coronary syndrome has been shown to be effective in reducing the risk of heart attack, stroke, and death, and its benefits outweigh the risks in most patients 1.

From the Research

Brilinta (Ticagrelor) Overview

• Brilinta, also known as ticagrelor, is a P2Y12 inhibitor used in patients with acute coronary syndrome (ACS) [(2,3,4,5,6)].
• It is often used in combination with aspirin as a dual antiplatelet therapy to reduce the risk of stent thrombosis and cardiovascular events [(3,6)].

Comparison with Clopidogrel

• Studies have compared the clinical outcomes of ticagrelor and clopidogrel in patients with ACS [(2,4,5)].
• One study found that ticagrelor and clopidogrel are associated with comparable clinical outcomes in patients with ACS, regardless of bleeding and ischemic risk 2.
• Another study found that ticagrelor was associated with a significantly lower risk of major adverse cardiovascular events (MACE) and hospitalization compared to clopidogrel after percutaneous coronary intervention (PCI) for ACS 5.

Clinical Outcomes and Safety

• The clinical outcomes of ticagrelor have been evaluated in several studies, including the risk of MACE, all-cause mortality, major bleeding, stroke, and hospitalization [(4,5)].
• One study found that prasugrel and ticagrelor are increasingly used in ACS patients and are associated with a lower number of recurrence of ACS or death compared to clopidogrel 4.
• Another study found that ticagrelor was associated with a decreased risk of MACE and all-cause hospitalization compared to clopidogrel, with no difference in the risk of major bleeding 5.

Guidance for Use

• Clinical guidelines recommend that patients with ACS be treated with dual oral antiplatelet therapy of aspirin plus clopidogrel, prasugrel, or ticagrelor [(3,6)].
• The selection of an appropriate antiplatelet agent depends on the treatment approach and a patient's bleeding risk and clinical history 6.
• Pharmacists can provide guidance on the appropriate use of antiplatelet agents, as well as the use of concomitant medications, while being vigilant for any potential drug interactions 6.