NICE draft guidance recommends new "clot-busting" drug to treat acute coronary syndromes

Final draft guidance published in mid-September by NICE confirms its previous positive draft recommendation for ticagrelor (Brilique, Astrazeneca). The draft guidance recommends ticagrelor within its licensed conditions (that is, in combination with aspirin and for up to 12 months) as an option to treat adults with acute coronary syndromes (ACS).

The term 'acute coronary syndromes' covers a range of conditions from unstable angina to myocardial infarction (heart attack). ACS are caused by thrombus (blood clot) formation following rupture of a plaque of fatty deposit (atheromatous plaque) in the coronary artery. This can cause the coronary artery to become progressively narrowed, affecting blood supply to the heart (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 ischaemia results 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. Every year around 200,000 people are diagnosed with ACS in England, of whom around three quarters have unstable angina or NSTEMI.

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 the treatment of people with ACS 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The draft guidance recommends the use of ticagrelor, in combination with aspirin, as a treatment option in people with STEMI who are to undergo primary percutaneous coronary intervention (PCI) and in people with NSTEMI. It is also recommended as a treatment option for people with unstable angina, which is defined as changes on electrocardiogram suggestive of ischaemia plus one characteristic associated with cardiovascular diseasei.