Brilinta Preferred Over Clopidogrel in Updated DAPT Guidelines

AstraZeneca announced that Brilinta (ticagrelor) is now preferred over clopidogrel for the management of patients with acute coronary syndrome (ACS) who have received a coronary stent, and in non-ST elevation acute coronary syndrome (NSTE-ACS) patients treated with medical therapy alone. That’s according to the American College of Cardiology (ACC) and American Heart Association (AHA) treatment guidelines.

This recommendation marks the first time Brilinta is preferred over clopidogrel in patients who have experienced a ST-elevation myocardial infarction (STEMI). The ACC/AHA guideline on the duration of antiplatelet therapy (DAPT) is also the first major U.S. guideline to expand indication for Brilinta use beyond 12 months in prior MI patients, who are not at high bleeding risk.

Specifically, the guideline highlights that patients with ACS treated with DAPT after BMS or DES implantation, should be given P2Y12 inhibitor therapy (eg, clopidogrel, prasugrel, or ticagrelor) for at least 12 months. Furthermore, for patients with ACS who are managed with medical therapy alone (without revascularization or fibrinolytic therapy) and treated with DAPT, P2Y12 inhibitor therapy (clopidogrel or ticagrelor) should be continued for at least 12 months. For patients with ACS being treated with DAPT who undergo CABG, P2Y12 inhibitor therapy should be resumed after CABG, to complete 12 months of DAPT therapy after ACS.

Brilinta, a P2Y12 inhibitor, was approved by the Food and Drug Administration (FDA) at a 60mg dose for patients with a history of MI in September 2015. It is indicated to reduce the rate of cardiovascular death, MI, and stroke in patients with acute coronary syndrome (ACS) or a history of MI. It also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.

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