From the Guidelines
Brilinta (ticagrelor) is indicated for patients with acute coronary syndrome (ACS) or history of heart attack, and it is recommended to use ticagrelor in preference to clopidogrel for maintenance P2Y12 inhibitor therapy in these patients 1. The standard dosing of Brilinta is typically 90 mg twice daily, often following an initial loading dose of 180 mg.
- Patients usually take Brilinta for at least 12 months after a cardiac event, though some may continue longer based on their risk factors.
- It should always be taken with low-dose aspirin (usually 75-100 mg daily).
- Common side effects include bleeding risk, shortness of breath, and headache.
- Patients should not stop taking Brilinta without consulting their doctor as sudden discontinuation can increase heart attack risk.
- Brilinta works by blocking P2Y12 receptors on platelets, preventing them from clumping together to form clots.
- This mechanism differs from clopidogrel (Plavix) as Brilinta binds reversibly to platelets and provides more consistent platelet inhibition.
- Patients should inform all healthcare providers about taking this medication before any procedures due to bleeding risk, and should avoid grapefruit products which can affect drug metabolism. In the PLATO trial, patients with ACS were treated with either medical therapy alone or medical therapy plus PCI, and treatment with ticagrelor 90 mg twice daily resulted in fewer ischemic complications and stent thromboses but more frequent non–CABG-related bleeding 1. The 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease also recommends ticagrelor or prasugrel in ACS patients unless drug-specific contraindications exist 1. The benefit/risk ratio of ticagrelor appears to be numerically more favorable for the 60-mg dose, although no formal statistical comparison was made 1.
From the Research
Indication for Brilinta (Ticagrelor)
- Brilinta (Ticagrelor) is indicated for patients with acute coronary syndrome (ACS) 2, 3, 4, 5, 6
- It is used in combination with aspirin as a dual antiplatelet therapy (DAPT) to reduce cardiovascular event rates after ACS 2, 3, 4, 5, 6
- The recommended duration of DAPT with ticagrelor is at least 12 months for patients with ACS, but may be prolonged up to 3 years in high-risk patients 2, 5
- Ticagrelor has been shown to be more potent than clopidogrel, with a faster onset of action and higher reductions in mortality 3, 5
- However, ticagrelor may also increase the risk of bleeding and dyspnea compared to clopidogrel 3, 6
Patient Selection
- Patients with a high risk of bleeding may require a shorter duration of DAPT or alternative antiplatelet therapy 2, 5
- Patients with a history of stroke or transient ischemic attack should avoid prasugrel, but ticagrelor may be a suitable alternative 2
- Patients older than 75 years or weighing less than 60 kg should be carefully considered for ticagrelor therapy due to increased risk of bleeding 2