What is the indication for Brilinta (Ticagrelor)?

From the Guidelines

Brilinta (ticagrelor) is indicated for patients with acute coronary syndrome (ACS) or a history of heart attack, with a standard dosing of 90 mg twice daily for the first year after a cardiac event, followed by 60 mg twice daily for long-term therapy, as recommended by the most recent guidelines 1. The primary use of Brilinta is to prevent blood clots in patients with ACS or a history of heart attack, by blocking P2Y12 receptors on platelets, preventing them from clumping together and forming dangerous clots. Some key points to consider when prescribing Brilinta include:

• The medication should be used in preference to clopidogrel for maintenance P2Y12 inhibitor therapy in patients with ACS treated with DAPT after coronary stent implantation, or in patients with NSTE-ACS treated with medical therapy alone 1.
• Patients taking Brilinta should avoid high-dose aspirin (over 100 mg daily) as it reduces effectiveness, and should inform all healthcare providers about this medication before procedures due to increased bleeding risk.
• Brilinta should not be suddenly discontinued as this could increase the risk of heart attack, stroke, or death from sudden blood clot formation.
• Common side effects include bleeding risk, shortness of breath, and headache. It's also important to note that the benefit/risk ratio of ticagrelor appears to be numerically more favorable for the 60-mg dose, although no formal statistical comparison was made between results of the 2 dosing regimens 1.

From the Research

Indication for Brilinta (Ticagrelor)

• Brilinta (Ticagrelor) is indicated for use in patients with acute coronary syndromes (ACS) 2, 3.
• The drug is used for the prevention of atherothrombotic events in adults with ACS, including those managed medically or with percutaneous coronary intervention or coronary artery bypass grafting (CABG) 3.
• Ticagrelor provides selective and reversible inhibition of adenosine diphosphate-induced platelet aggregation, with a faster onset and offset of action than that of clopidogrel 2, 3.
• The FDA approved ticagrelor for use during acute coronary syndromes, with a 'black box' warning for bleeding risks and a unique warning that higher than 100 mg/daily maintenance treatment with aspirin may reduce ticagrelor effectiveness 4.

Patient Population

• Ticagrelor is effective in the treatment of patients with ACS, with or without ST-segment elevation 3.
• The drug is particularly useful in patients at high risk of ischemic events or unresponsive to clopidogrel 3.
• In the PLATO trial, ticagrelor was more effective than clopidogrel in reducing the incidence of the primary composite endpoint of myocardial infarction, stroke, or cardiovascular death in adult patients with ACS 2, 5.

Efficacy and Safety

• Ticagrelor has been shown to reduce the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding, but with an increase in the rate of non-procedure-related bleeding 5.
• The risk of major bleeding with ticagrelor, including bleeds related to CABG, did not differ from that seen with clopidogrel in the PLATO trial, although ticagrelor was associated with more non-CABG-related major bleeds and fatal intracranial bleeding 3, 5.