16 August 2016

Thousands to Benefit as NICE Set to Recommend Drug to Prevent Heart Attacks and Strokes

NICE has published draft guidance recommending anti-clotting drug ticagrelor 60 mg with aspirin for people who have had a heart attack.

In 2012/13 there were around 140,000 hospital admissions for heart attacks in England.

Heart attacks and strokes are caused by the build-up of fatty material in artery walls to form a plaque. If the plaque ruptures it can cause a blood clot which can block blood flow to heart muscles causing a heart attack.

If the blood clot dislodges it can travel in the blood stream and block blood flow to the brain causing a stroke.

People who have had a heart attack are at higher risk of having a further heart attack or stroke. Current treatment to prevent this happening includes making lifestyle changes such as exercise, stopping smoking and eating a healthier diet. It also includes the use of anti-clotting drugs (also called antiplatelets), including aspirin, to reduce the risk of blood clots forming. 

Professor Carole Longson MBE, 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.”

NICE is looking at the use of ticagrelor at a lower dose beyond the initial 12 month period as a continuation of their previous ticagrelor treatment.

It recommends ticagrelor 60 mg, which costs about £1 per tablet, with aspirin, taken twice a day for up to three years for people who have had a heart attack at least 12 months ago and who remain at high risk of having a further heart attack or stroke. The draft guidance states there should no interruption between treating at the higher 90 mg dose and the lower 60 mg dose.   

Because there is limited data on ticagrelor’s efficacy and safety, particularly the risk of bleeding, beyond three years, the draft guidance does not recommend treatment with ticagrelor beyond that period.