The draft guidance recommends use of ticagrelor at the lower dose of 60mg alongside aspirin for up to three years to following initial treatment to help reduce risk of heart attacks and strokes.
Ticagrelor at a higher 90mg dose with aspirin is already standard treatment for 12 months following a heart attack. Patients were previously advised to take aspirin alone after this time.
NICE said thousands of patients would reap the benefits of the new recommendation, which comes at a cost of £2 per daily dose.
The 60mg treatment should follow from the 90mg dose ‘without interruption’ and continue for up to three years or until clinically indicated, it recommended.
NICE said it decided to put the cap at three years due to ‘limited data’ on the drug’s efficacy and safety over longer periods than this – particularly regarding how it could affect bleeding risk.
Heart attack prevention
Ticagrelor (Brilique, AstraZeneca) is an oral antagonist of the P2Y12 adenosine diphosphate receptor that inhibits platelet aggregation and thrombus formation. A 60mg dose costs around £1 per pill, which patients take twice a day.
Professor Carole Longson, 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The draft guidance is open for consultation until 5pm Monday 5 September.