Ticagrelor (Brilinta)

[VFlutter]

I just had an inservice about a new antiplatelet medication, Brilinta, and thought I would share some basic information about it. Some of our cardiologists, especially our interventional cardiologists, have started to prescribe it so you may see it on home medication lists.

Brilinta is an oral antiplatelet medication similar to Clopidogrel (Plavix) and Prasugrel (Effient). It is an ADP receptor/P2Y12 inhibitor but has a different binding site than Plavix and is reversible with a quicker onset and offset of action.

According to the PLATO trial....

"In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non–procedure-related bleeding"

http://www.nejm.org/doi/full/10.1056/NEJMoa0904327

Seems to be a pretty good alternative to Plavix and Effient for ACS/STEMI. Apparently it significantly lowers stent thrombosis rates post PCI but I could not find any data. Also according to the Astra-Zeneca rep it is cheaper than the generic plavix on most insurance plans.

 

[DrankTheKoolaid]

re

Good Stuff

 

[boerbull]

Where I work this is standard in our STEMI protocol. We started last year November. It replaced the plavix

 

[systemet]

We use it for patients targeted for PCI too, but stil give plavix if we're giving TNK. Apparently one of the advantages over plavix is that ticagrelor doesn't require biotransformation for activity. A major drawback with plavix is that a fair percentage of the population are nonresponders and lack the necessary enzymes to convert plavix into its active metabolite.