NICE recommends thousands to receive £2-a-day anti-clotting drug

15 August 2016  •  Author: National Institute for Health and Care Excellence (NICE)

NICE has published draft guidance recommending anti-clotting drug ticagrelor 60 mg (Brilique, Astrazeneca) with aspirin for people who have had a heart attack.

A higher dose of ticagrelor is already recommended for 12 months after a heart attack. Now new draft guidance is recommending it is continued in these people at a lower dose for a further three years to reduce their risk of a further heart attack or stroke. It recommends ticagrelor 60 mg, which costs about £1 per tablet, with aspirin, taken twice a day for up to three years, to treat people who remain at high risk of having a further heart attack or stroke.

Risk of heart attack

Heart attacks and strokes are caused by the build-up of fatty material in artery walls to form a plaque. If the plaque ruptures it can cause a blood clot which can block blood flow to heart muscles causing a heart attack.

If the blood clot dislodges it can travel in the blood stream and block blood flow to the brain causing a stroke.

People who have had a heart attack are at higher risk of having a further heart attack or stroke. Current preventive treatment includes making lifestyle changes such as exercise, stopping smoking and eating a healthier diet. It also includes the use of anti-clotting drugs (antiplatelets), including aspirin, to reduce the risk of blood clots forming.

A growing health issue

In 2013 there were over 140,000 hospital admissions for heart attacks in England.

Professor Carole Longson MBE, NICE health technology evaluation centre director, said, “Despite the availability of effective secondary prevention treatments 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.”

“Fear of a recurrence can have a significant negative impact on a person’s quality of life. 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. 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 from it.”

The future of ticagrelor

Because there is limited data on ticagrelor’s efficacy and safety, particularly the risk of bleeding, beyond three years, the draft guidance does not recommend treatment with ticagrelor beyond that period.

Until final guidance is issued, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its final guidance on a technology, it replaces local recommendations across the country.

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