Brilinta for preventing heart attacks, stroke, and complications after acute coronary syndrome

Brilinta (ticagrelor) is an oral medication that helps reduce the risk of serious cardiovascular problems such as heart attack, stroke, and cardiovascular death. It is primarily used in patients with acute coronary syndrome (ACS), a history of myocardial infarction (heart attack), coronary artery disease at high risk of events, or after certain types of stroke. Brilinta works by inhibiting platelet aggregation to prevent blood clots.

• Acute coronary syndrome (ACS) or history of myocardial infarction (MI): To reduce risk of cardiovascular death, MI, stroke, and stent thrombosis. Treatment is for at least 12 months and is superior to clopidogrel in this setting.
• Coronary artery disease without prior stroke or MI: To reduce risk of a first MI or stroke in patients with CAD at high risk for such events, with efficacy shown notably in patients with type 2 diabetes mellitus.
• Acute ischemic stroke or high-risk transient ischemic attack (TIA): To reduce risk of stroke in patients with mild stroke (NIH Stroke Scale ≤5) or high-risk TIA.

ticagrelor

Brilinta contains ticagrelor, which reversibly inhibits the P2Y12 receptor on platelets, a key receptor involved in platelet activation and aggregation. By blocking this receptor, Brilinta prevents platelets from clumping together, thereby reducing the formation of potentially dangerous blood clots that can lead to heart attacks, strokes, or stent thrombosis.

Acute coronary syndrome or history of myocardial infarction

• Start with a 180 mg oral loading dose.
• Then take 90 mg twice daily for the first 12 months.
• After 1 year, reduce dose to 60 mg twice daily.
• Use with daily aspirin 75-100 mg; consider single antiplatelet therapy with Brilinta alone in patients post-PCI based on bleeding and thrombotic risk.

Coronary artery disease without prior stroke or MI

• Administer 60 mg twice daily with aspirin 75-100 mg daily.

Acute ischemic stroke or high-risk TIA

• Start with 180 mg loading dose, then 90 mg twice daily for up to 30 days.
• Use with aspirin loading dose 300-325 mg and maintenance aspirin 75-100 mg daily.

Additional instructions

• If a dose is missed, take the next dose at the scheduled time; do not double doses.
• Tablets can be crushed and mixed with water for patients unable to swallow whole; can be administered via a nasogastric tube (CH8 or greater).
• Do not use with other oral P2Y12 inhibitors.
• Avoid aspirin doses higher than recommended.

• History of intracranial hemorrhage
• Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage)
• Hypersensitivity to ticagrelor or any component of Brilinta

Bleeding risk

• Brilinta increases the risk of significant and potentially fatal bleeding.
• It is contraindicated in patients with active pathological bleeding or a history of intracranial hemorrhage.
• Do not start Brilinta in patients undergoing urgent coronary artery bypass graft (CABG) surgery.
• If bleeding occurs, manage without stopping Brilinta if possible; stopping treatment increases risk of cardiovascular events.
• Interrupt Brilinta 5 days before surgery with high bleeding risk when possible and restart after hemostasis.

Dyspnea

• Dyspnea occurs in approximately 14-21% of patients; usually mild to moderate and often resolves without treatment.
• No specific treatment is required; continue treatment if possible.
• If intolerable dyspnea develops, consider switching to another antiplatelet agent.

Bradyarrhythmias

• Brilinta can cause ventricular pauses and bradyarrhythmias.
• Avoid use in patients with sick sinus syndrome, high-grade AV block, or bradycardia-related syncope without a pacemaker.

Severe hepatic impairment

• Avoid use in patients with severe liver impairment due to likely increased drug exposure.

Central sleep apnea

• Cases of central sleep apnea including Cheyne-Stokes respiration have been reported; consider assessment if suspected.

Laboratory interference

• Brilinta can cause false-negative results in platelet function tests used to diagnose heparin-induced thrombocytopenia (HIT).
• It does not affect PF4 antibody testing.

Common adverse reactions (>5%)

• Bleeding events, including major and minor bleeding
• Dyspnea

Other adverse reactions observed (≥3%)

• Dizziness
• Nausea
• Diarrhea

Serious bleeding

• Fatal and intracranial bleeding have been reported but are less common.

Do not administer Brilinta with other oral P2Y12 platelet inhibitors. Avoid aspirin doses above 100 mg daily to minimize bleeding risk.