Is there data on reduced dosing of Brilinta (Ticagrelor) for Coronary Artery Disease (CAD)?

From the Guidelines

There is no direct evidence supporting reduced dosing of Brilinta (Ticagrelor) for Coronary Artery Disease (CAD) in the provided studies. The most recent and highest quality study, 1, focuses on the benefits and risks of dual antiplatelet therapy (DAPT) in coronary artery disease, but does not specifically address reduced dosing of Ticagrelor.

Key Points

• The study 1 emphasizes the importance of individualized approach based on ischemic vs. bleeding risk assessment for DAPT duration.
• It recommends Clopidogrel as the default P2Y12 inhibitor in patients with stable CAD treated with PCI, while Ticagrelor or Prasugrel is recommended in ACS patients unless drug-specific contraindications exist.
• The study 1 discusses the management of patients with non-ST-elevation acute coronary syndromes, including the use of antiplatelet therapy in patients with chronic kidney disease (CKD), but does not provide information on reduced dosing of Ticagrelor.

Clinical Considerations

• In clinical practice, the decision to reduce the dose of Ticagrelor should be based on individual patient factors, such as bleeding risk and ischemic risk.
• Patients with high bleeding risk may require closer monitoring and potentially reduced doses of antiplatelet therapy, while those with high ischemic risk may benefit from continued full-dose therapy.
• However, without direct evidence from high-quality studies, any decision to reduce the dose of Ticagrelor should be made with caution and careful consideration of the potential risks and benefits.

Monitoring and Management

• Patients on Ticagrelor should be closely monitored for bleeding complications, even at standard doses.
• The use of aspirin (typically 81mg daily) in combination with Ticagrelor is recommended, and patients should be educated on the signs and symptoms of bleeding complications.

From the Research

Reduced Dosing of Brilinta (Ticagrelor) for Coronary Artery Disease (CAD)

• There is limited data available on reduced dosing of Brilinta (Ticagrelor) for Coronary Artery Disease (CAD) 2, 3, 4, 5, 6.
• The standard maintenance dose of ticagrelor is 90 mg twice daily, but some studies have explored the use of lower doses, such as 60 mg twice daily, in certain patient populations 3.
• A study comparing standard maintenance-dose clopidogrel versus low-dose prasugrel in patients with stable coronary artery disease after percutaneous coronary intervention found that low-dose prasugrel achieved more consistent antiplatelet effects than clopidogrel, but did not provide data on ticagrelor dosing 3.
• Another study found that ticagrelor did not improve major adverse cardiovascular events and all-cause mortality compared to clopidogrel in patients with acute coronary syndrome and severe renal insufficiency, but significantly increased the risk of bleeding 4.
• The PLATO trial found that ticagrelor compared to clopidogrel reduced the primary composite end point of cardiovascular death, myocardial infarction, and stroke at 12 months in patients with acute coronary syndromes, but did not provide data on reduced dosing of ticagrelor 5.
• The TROUPER trial is an ongoing study comparing the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy, but has not yet reported results on reduced dosing of ticagrelor 6.