EMed

Ticagrelor in ACS or pre-PCI

Ticagrelor (Brilique ™)

Dose

180mg po stat loading dose (orodispersible (SPC) or film coated tablets) to all patients regardless of type of ACS, management strategy, age or body weight.

Ticagrelor is stored in the CUH resusc. room press.

Maintenance dose 90mg po bd

Precautions with Tigacrelor (Brilique)

  • The use of Tigacrelor (Brilique) in patients with known ↑ risk for bleeding should be balanced against the benefit in terms of prevention of atherothrombotic events
  • The concomitant use of Tigacrelor (Brilique) with doses of Simvastatin >40mg is not recommended
  • Tigacrelor (Brilique) should be used with caution in patients at risk of bradycardic events
  • Tigacrelor (Brilique) should be used with caution in patients with history of asthma and/or COPD
  • Creatinine levels may increase during treatment with Tigacrelor (Brilique). Renal function should be checked after 1 month

Switching Clopidogrel Patients

Patients treated with clopidogrel can be directly switched to Tigacrelor (Brilique).

Contraindications with Tigacrelor (Brilique)

  • Hypersensitivity to the active substance (ticagrelor) or to any of the excipients
  • Active pathological bleeding
  • History of intracranial haemorrhage
  • Moderate-to-severe hepatic impairment
  • Combination with strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir

Prasugrel (Effient)

In combination with Aspirin, may be used as an alternative to Clopidogrel in patients presenting with ACS (acute coronary syndromes) who are likely to undergo PCI (percutaneous coronary intervention).

Although Prasugrel was associated with a reduction of major adverse cardiac events across a wide range of patients when compared to Clopidogrel in the Triton-TIMI 38 study (Ref 1), the greatest benefit was seen in the following subgroups (Ref 2):

  1. Patients undergoing immediate primary PCI
  2. History of stent thrombosis on Clopidogrel
  3. Patients with diabetes mellitus

Prasugrel dose

  • 60 mg loading
  • 10 mg od maintenance

Prasugrel is contraindicated if:

  • Age > 75 yr
  • Weight < 60 kg
  • Previous TIA or stroke

Content by Dr Ronan Curtin , Dr Íomhar O' Sullivan 12/04/2011. Last review Dr ÍOS 27/11/22.