NICE recommends dual antiplatelet therapy with ticagrelor and aspirin


The National Institute of Health and Care Excellence (NICE) has published a final appraisal determination that states dual antiplatelet therapy with ticagrelor 60mg (Brilique, AstraZeneca) and aspirin is a potential option for patients who have had a myocardial infarction and are at high risk of a further event. It advises that treatment should be stopped when clinically indicated or at a maximum of three years.

Ticagrelor 90mg, in combination with low dose aspirin, is already recommended by NICE and the Scottish Medicines Consortium as a treatment option for the prevention of atherothrombotic events in adults with acute coronary syndrome for up to 12 months only. The new recommendation from NICE means that, in future, patients within NHS England and Wales who have a history of myocardial infarction of at least one year and a high risk of another event may continue treatment with ticagrelor 60mg twice daily with aspirin to a maximum of three years, or when cessation of treatment is clinically indicated.

Treatment is recommended in line with the marketing authorisation and may be started without interruption (continuation therapy) after the initial one-year treatment with ticagrelor 90mg or another adenosine disphosphate (ADP) receptor inhibitor therapy in patients with acute coronary syndrome and with a high risk of an atherothrombotic event. Treatment can also be started up to two years from the myocardial infarction or within one year after stopping previous ADP receptor inhibitor treatment.

Rob Storey (University of Sheffield, UK) says: “Secondary prevention for myocardial infarction patients is critically important for their physical and psychological wellbeing. Today’s NICE recommendation is an important step forward in enabling us as clinicians to continue reducing patients’ risk of a further atherothrombotic event, including another heart attack or stroke, in the first few years following an initial heart attack.”

After a consultation period on the final appraisal determination, NICE will publish final technology appraisal guidance for ticagrelor 60mg. After this, the treatment may be funded and accessible on the NHS within 90 days.