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NICE draft guidance recommends new "clot-busting" drug to treat acute coronary syndromes

30th June 2011

In draft guidance published today (30 June) NICE has recommended ticagrelor (Brilique, Astrazeneca) in combination with aspirin as an option to treat adults with acute coronary syndromes.
 
Acute coronary syndromes refer to a group of heart problems ranging from myocardial infarction (heart attacks) to unstable angina, which occur due to narrowed coronary arteries. They are usually caused by coronary heart disease where cholesterol-rich deposits, or plaques, form within the walls of coronary arteries (atherosclerosis). This can cause the coronary artery to become progressively narrowed, and blood supply to the heart is affected (ischaemia).
 
ST-segment-elevation myocardial infarction (STEMI) and Non-ST-segment-elevation myocardial infarction (NSTEMI) (the names come from the pattern seen on an ECG, which measures the rhythm and electrical activity of the heart) happens when the plaques tear, forming blood clots that block the coronary artery resulting in damage to the heart muscle. Where the blood supply to the heart is blocked, but there is no evidence of actual damage to the heart muscle, the clinical syndrome is described as unstable angina. ACS becomes more common with increasing age and incidence is higher in men than women.
 
Ticagrelor belongs to a class of drugs called anti-platelets. These work by reducing or preventing the formation of blood clots. Ticagrelor is licensed for people with acute coronary syndromes who are managed medically or who are having a procedure called a percutaneous coronary intervention to widen narrowed arteries in the heart. The draft guidance recommends ticagrelor in combination with aspirin as a treatment option in adults with acute coronary syndrome, including those with STEMI and NSTEMI. It also recommends ticagrelor in combination with aspirin as a treatment option for unstable angina in hospitalised patients who have changes on an ECG suggestive of ischaemia and a risk factor for cardiovascular disease.
 
Dr Carole Longson, NICE Health Technology Evaluation Centre Director, said: "Ticagrelor is the latest in an ever increasing number of important new drugs and interventional techniques that have been shown to reduce deaths in patients with ACS. From the evidence considered, the independent Appraisal Committee concluded that, compared with clopidogrel, reductions in MI and death from vascular causes were significant - 16% and 21% respectively - for patients randomised to the ticagrelor group. All anti-platelets, because of their mechanism of action, can cause bleeding. Importantly, the same evidence showed that there was no significant difference in the primary safety endpoint of ‘major' bleeding between ticagrelor and clopidogrel."
 
NICE has not yet issued final guidance to the NHS. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. NICE's preliminary guidance is available for public consultation on the NICE website until 21 July2011. Feedback received during consultation may result in changes to the preliminary recommendations and will be considered by the Appraisal Committee at their next meeting.

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Comments

Micheal Thompson

Wednesday 6th July 2011 @ 17:46

This is a great article, and thank you for sharing! If you are a physician and need continuing medical education check out www.ipoccme.com. This site has great CME opportunities.


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