NOW UPDATED
2014 AHA/ACC
NSTE-ACS GUIDELINE
BRILINTA PREFERRED OVER
CLOPIDOGREL FOR THE
MANAGEMENT OF NSTE-ACS
(CLASS IIa)3
Class IIa (LOE: B) recommendation for the
preferred use of BRILINTA® (ticagrelor) tablets
over clopidogrel in NSTE-ACS patients with
early invasive or ischemia-guided strategy or
receiving a coronary stent ¶
Class I (LOE: B) recommendation for BRILINTA
as a treatment option in the management
of NSTE-ACS patients¶#
BLEEDING AT 12 MONTHS, there was no significant
difference in Total Major Bleeding (which includes Fatal
and Life-threatening bleeding) for BRILINTA plus aspirin
vs clopidogrel plus aspirin (11.6% vs 11.2%).††
There was a somewhat greater risk of Non–CABG-related
Major plus Minor Bleeding for BRILINTA plus aspirin vs
clopidogrel plus aspirin (8.7% vs 7.0%) and Non–CABGrelated Major Bleeding (4.5% vs 3.8%), respectively.††
PLATO trial did not show an advantage for BRILINTA
compared with clopidogrel for CABG-related Bleeding
(Total Major 85.8% vs 86.9% and Fatal/Life-threatening
48.1% vs 47.9%, respectively). When antiplatelet therapy
was stopped 5 days before CABG, Major Bleeding occurred
in 75% of patients treated with BRILINTA and 79% of
patients on clopidogrel.1††
WARNINGS AND PRECAUTIONS
• Moderate Hepatic Impairment: Consider the risks and
benefits of treatment, noting the probable increase in
exposure to ticagrelor
• Premature discontinuation increases the risk of MI, stent
thrombosis, and death
• Dyspnea was reported in 14% of patients treated with
BRILINTA and in 8% of patients taking clopidogrel.
Dyspnea resulting from BRILINTA is self-limiting. Rule out
other causes
• BRILINTA is metabolized by CYP3A4/5. Avoid use with
strong CYP3A inhibitors and potent CYP3A inducers. Avoid
simvastatin and lovastatin doses >40 mg
• Monitor digoxin levels with initiation of, or any change in,
BRILINTA therapy
PROVEN SUPERIOR TO
CLOPIDOGREL IN REDUCING
CV DEATH AT 12 MONTHS
PLATO CV death secondary end point in ACS patients: RRR with
BRILINTA plus aspirin was 21% (ARR 1.1%) vs clopidogrel plus aspirin1§
INDICATIONS
BRILINTA is indicated to reduce the rate of thrombotic
cardiovascular (CV) events in patients with acute coronary
syndrome (ACS) (unstable angina, non–ST-elevation myocardial
infarction,