Ticagrelor ‘now on equal footing’ with other antiplatelets

By Piriya Mahendra

The platelet aggregation inhibitor ticagrelor is now considered of equal effectiveness to clopidogrel and prasugrel for patients who have experienced a heart attack or have unstable angina, a report states.

The focused update on unstable angina and non-ST-segment elevation myocardial infarction (non-STEMI) also continues to recommend that all patients with these conditions receive aspirin immediately after hospitalization, for as long as it is tolerated.

The joint updated guidelines were issued by the American Heart Association Task Force on Practice Guidelines and the American College of Cardiology Foundation.

The report, published in Circulation, also says that patients who are unable to take aspirin may take prasugrel (loading dose followed by daily maintenance dose) for coronary artery-opening procedures.

Patients who undergo invasive procedures should receive both aspirin (81 mg if taking with ticagrelor) and another antiplatelet medication.

And patients who undergo medical therapy only should receive aspirin indefinitely and clopidogrel or ticagrelor (loading dose followed by maintenance dose) after admission for up to 12 months.

The guidelines also state that ticagrelor 180 mg should be given as early as possible before or at the time of percutaneous coronary intervention.

"We have put [ticagrelor] on an equal footing with two other antiplatelet medications, clopidogrel and prasugrel," explained lead author of the update, Hani Jneid (Baylor College of Medicine, Houston, Texas, USA) in a press statement.

The authors encourage clinicians and hospitals to participate in a quality of care data registry to measure outcomes, complications, and adherence to evidence-based recommendations.

Jneid remarked that although the updated guidelines provide important guidance to clinicians, the recommendations included do not substitute physicians' individual clinical judgments and treatments tailored to an individual's condition.

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