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NICE backs longer treatment with anti-clotting drug

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Latest draft guidelines for the NHS recommend a £2-a-day anti-clotting drug be used for up to three years to reduce the further risk of cardiovascular events in heart attack patients.

NICE has today published draft guidance recommending the drug ticagrelor 60mg (Brilique) in combination with aspirin as secondary prevention in myocardial infarction patients.

“We are pleased to be able to increase the treatment options available”

Carole Longson

The drug, manufactured by AstraZeneca, is an oral antagonist of the P2Y12 adenosine diphosphate receptor that inhibits platelet aggregation and thrombus formation in atherosclerotic disease.

A higher dose of ticagrelor is already recommended for 12 months post-MI. The new draft guidance is recommending it is continued at a lower dose for a further three years.

NICE said most UK centres already used the 90mg dose of ticagrelor with aspirin for secondary prevention for up to a year, after which aspirin could be continued indefinitely.

The new draft guidance looks at the use of ticagrelor at a lower dose beyond the initial 12-month period as a continuation of their previous ticagrelor treatment.

It recommends ticagrelor 60mg, which costs about £1 per tablet, with aspirin, taken twice a day for up to three years for people who have had an MI at least 12 months ago and who remain at high risk of having a further heart attack or stroke.

The draft guidance states there should no interruption between treating at the higher 90mg dose and the lower 60mg dose.

However, because of limited data on ticagrelor’s efficacy and safety – particularly the risk of bleeding – beyond three years, the draft does not support using it for the longer term.

Professor Carole Longson, director of NICE’s health technology evaluation centre, said: “As many as a quarter of people who have had a heart attack go on to have another heart attack or stroke – often with devastating consequences.

Professor Carole Longson

Professor Carole Longson

Professor Carole Longson

“The evidence shows that ticagrelor, in combination with aspirin, is effective at reducing the risk of further heart attacks and strokes in people who have already had a heart attack,” she said.

She added: “In provisionally recommending ticagrelor, we are pleased to be able to increase the treatment options available to the many thousands of people who stand to benefit.”

A consultation on the draft guidance will run until 5 September. The next version of the draft guidance will be issued after a NICE meeting on 14 September.

Until final guidance is issued, NICE noted that NHS bodies will make decisions locally on funding the treatment.

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