National Institute for Health and Clinical Excellence (NICE)
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NICE gives green light to new clot-busting drug
GPs will be able to prescribe ticagrelor (Brilique), in combination with low-dose aspirin for up to 12 months, for patients with acute coronary syndromes (ACS), following final guidance from NICE.
ACS are caused by thrombus formation following rupture of a plaque of fatty deposit in the coronary artery. This can cause the coronary artery to become progressively narrowed, affecting blood supply to the heart.
Every year around 200,000 people are diagnosed with ACS in England, of whom around three quarters have unstable angina or and Non-ST-segment-elevation myocardial infarction (NSTEMI).
Ticagrelor is an anti-platelet drug which works by reducing or preventing the formation of blood clots.
It is licensed for the treatment of people with ACS who are managed medically or who are having a procedure called a percutaneous coronary intervention to widen narrowed arteries in the heart.
NICE recommends that the drug be used, in combination with aspirin, as a treatment option in people with STEMI who are to undergo primary percutaneous coronary intervention (PCI) and in people with NSTEMI.
It is also recommended as a treatment option for people with unstable angina, which is defined as changes on electrocardiogram suggestive of ischaemia plus one characteristic associated with cardiovascular disease.
Patients admitted to hospital with unstable angina could also benefit from ticagrelor, says NICE.
Before ticagrelor is continued beyond the initial treatment, the diagnosis of unstable angina should first be confirmed, ideally by a cardiologist.
Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “The evidence shows that ticagrelor, in combination with aspirin, is effective at reducing MI and deaths from cardiovascular causes.
“Today's guidance, in recommending the use of ticagrelor where clinically appropriate, is an affirmation of that effectiveness and good news for patients with ACS, wherever they live in England and Wales, because it increases the number of treatment options available to them.”
Dr Terry McCormack, a GP in North Yorkshire and former chair of the Primary Care Cardiovascular Society, welcomed the guidance as it increases the options for patients with ACS.
“Ticagrelor is different to clopidogrel and other antiplatelets, such as prasugrel, in that it acts on a different platelet receptor and is therefore effective in people who are resistant to the effects of clopidogrel.”
NICE has produced a clinical audit tool tool to help put this recommendation into practice.
