From the Guidelines
Brilinta (ticagrelor) is not recommended for DVT prophylaxis. Ticagrelor is an antiplatelet medication primarily used for preventing cardiovascular events in patients with acute coronary syndrome or history of myocardial infarction. For DVT prophylaxis, anticoagulants such as low molecular weight heparins (enoxaparin 40mg daily), unfractionated heparin (5000 units 2-3 times daily), direct oral anticoagulants (apixaban 2.5mg twice daily, rivaroxaban 10mg daily), or warfarin are the standard of care 1. These medications work by inhibiting the coagulation cascade, while ticagrelor works by inhibiting platelet aggregation, which is not the primary mechanism involved in venous thrombosis formation. Using the appropriate medication class is crucial because DVT formation primarily involves activation of the coagulation cascade rather than platelet activation, making anticoagulants more effective than antiplatelet drugs for this specific indication.
Some key points to consider:
- The American College of Physicians and the American Academy of Family Physicians recommend the use of anticoagulants such as low molecular weight heparins or unfractionated heparin for the prevention of DVT in hospitalized patients 1.
- The American Heart Association/American Stroke Association recommends the use of intermittent pneumatic compression (IPC) in addition to routine care for immobile stroke patients without contraindications to reduce the risk of DVT 1.
- The American Society of Hematology recommends the provision of pharmacological VTE prophylaxis in acutely or critically ill inpatients at acceptable bleeding risk, and the use of mechanical prophylaxis when bleeding risk is unacceptable 1.
Overall, the evidence suggests that anticoagulants, not antiplatelet medications like ticagrelor, are the preferred choice for DVT prophylaxis.
From the Research
Deep Vein Thrombosis Prophylaxis
There are no research papers to assist in answering this question regarding the use of Brilinta (ticagrelor) for Deep Vein Thrombosis (DVT) prophylaxis.
Available DVT Prophylaxis Methods
Some of the available methods for DVT prophylaxis include:
- Rivaroxaban, an oral direct factor Xa inhibitor, which is approved for the initial treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as the prevention of recurrent DVT and PE 2
- Graduated compression stockings, which are among the most commonly available and accepted methods of external compression for the prophylaxis of DVT 3
- Enoxaparin, a low-molecular-weight heparin, which has been compared with unfractionated heparin (UFH) for treatment of deep vein thrombosis (DVT) 4
- Intermittent pneumatic compression (IPC), which has been shown to reduce the incidence of VTE, DVT, and PE in neurosurgical patients 5
- Comparison of IPC and graduated compression stockings (GCS) for DVT prophylaxis, with some studies showing IPC to have a lower DVT rate 6