Duration of Ticagrelor (Brilinta) Therapy for Acute Coronary Syndrome
Ticagrelor (Brilinta) should NOT be taken for life but rather for a recommended duration of 12 months after an acute coronary syndrome event, unless there are specific indications for shorter or extended therapy.
Standard Duration Recommendations
According to current guidelines, the standard recommended duration for ticagrelor therapy is:
- 12 months for patients with acute coronary syndrome (ACS), regardless of whether they received medical management or underwent stent placement 1
- This 12-month recommendation is considered a Class I recommendation with Level A/B evidence across major cardiology societies 1
Considerations for Duration Modification
Shorter Duration (6 months)
- For patients at high bleeding risk (e.g., PRECISE-DAPT score ≥25), discontinuation after 6 months should be considered 1, 2
- This is a Class IIa recommendation with Level B evidence 1
Extended Duration (Beyond 12 months)
- May be considered in select patients who have tolerated DAPT without bleeding complications 1
- This is a Class IIb recommendation with Level A/B evidence 1
- For patients with MI and high ischemic risk, ticagrelor 60mg twice daily (reduced maintenance dose) may be preferred for extended therapy 1
Special Considerations
Stent Type
- Drug-eluting stents (DES): Minimum 12 months of DAPT recommended 1
- Bare metal stents (BMS): Up to 12 months of DAPT recommended 1
Bleeding Risk Assessment
- Regular evaluation of bleeding risk is essential during treatment 2
- Consider adding a proton pump inhibitor to reduce gastrointestinal bleeding risk 2
Discontinuation Before Surgery
- If non-urgent surgery is needed, ticagrelor should be discontinued ≥5 days before the procedure 1, 2
- For urgent surgery, the heart team should assess individual bleeding and ischemic risks 1
Medication Details
- Ticagrelor is a reversible, direct-acting P2Y12 receptor inhibitor with faster onset and more pronounced platelet inhibition than clopidogrel 3, 4
- Standard dosing: 180mg loading dose, followed by 90mg twice daily maintenance 1, 2
- Must be used with low-dose aspirin (75-100mg daily) - higher aspirin doses may reduce ticagrelor's effectiveness 5
Important Warnings
- Premature discontinuation increases risk of stent thrombosis, myocardial infarction, and death
- Never stop ticagrelor without consulting your cardiologist
- Common side effects include increased non-CABG related bleeding and dyspnea (usually mild to moderate) 3, 6
Remember that these recommendations are based on current guidelines, and your specific situation should be discussed with your cardiologist who can consider your individual risk factors for both bleeding and thrombotic events.