AHA/ACC Guideline Expands Antiplatelet Options

The antiplatelet agent ticagrelor, approved by the FDA in 2011, should be considered as an option along with clopidogrel and prasugrel to treat patients with unstable angina or non-ST-elevation myocardial infarction.

This is one of several new recommendations included in a focused guideline update issued jointly last week by the American Heart Association and the American College of Cardiology. The update is published in the July issue of the Journal of the American College of Cardiology.

•  Have ticagrelor and prasugrel become the agents of choice over clopidogrel?

•  How does ticagrelor differ from each of the other primary antiplatelet agents? Is is appropriate for all ACS patients? 

•  Were there any changes made to recommendations on the use of aspirin in patients with ACS?

We asked Dr Christopher Cannon to answer these questions and to point out how the guideline updates may affect prescribing in primary care. Dr Cannon, a senior investigator with the TIMI Study Group, is editor-in-chief of Cardiosource Science and Quality. He is also Professor of Medicine at Harvard Medical School and Associate Physician in the Cardiovascular Division of Brigham and Women’s Hospital in Boston.

Podcast: Ticagrelor is In: AHA/ACCF Focused Guideline Update

Take-home Points

•  Ticagrelor, a new stronger P2Y12 inhibitor that is an alternative to clopidogrel for patients with unstable angina/non-ST elevation myocardial infarction, is now recommended in clinical guidelines issued by the American Heart Association and American College of Cardiology.

•  Compared with clopidogrel, ticagrelor has a greater antiplatelet effect and reduces both death or recurrent MI.

•  Ticagrelor is a reversible agent and is given twice daily; it can be given in the emergency department and continued for 1 year for both medically managed patients and those who have undergone PCI or CABG.

•  Ticagrelor joins prasugrel, the other guideline-recommended stronger P2Y12 inhibitor, as an option for antiplatelet therapy; prasugrel, however, is only recommended for ACS patients for whom PCI is planned and is not appropriate, at present, for those whose UA/NSTEMI event is managed medically.

Reference
Jneid H, Anderson JL, Wright RS, et al.  2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update). J Am Coll Cardiol. 2012;60:653–689.
Also available at: http://content.onlinejacc.org/article.aspx?articleid=1217906.