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NICE - Ticagrelor for preventing atherothrombotic events after myocardial infarction (MI)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • Ticagrelor, in combination with aspirin, is recommended within its marketing authorisation as an option for preventing atherothrombotic events in adults who had a myocardial infarction and who are at high risk of a further event
    • treatment should be stopped when clinically indicated or at a maximum of 3 years

Ticagrelor is an oral antagonist of the P2Y12 adenosine diphosphate receptor that inhibits platelet aggregation and thrombus formation in atherosclerotic disease.

Ticagrelor 60 mg twice daily is the recommended dose when extended treatment is needed for patients with a history of myocardial infarction of at least 1 year and a high risk of an atherothrombotic event. Treatment may be started without interruption (continuation therapy) after the initial 1-year treatment with ticagrelor 90 mg or other adenosine diphosphate (ADP) receptor inhibitor therapy in patients with acute coronary syndromes and with a high risk of an atherothrombotic event.

Treatment can also be started up to 2 years from the myocardial infarction, or within 1 year after stopping previous ADP receptor inhibitor treatment.

Unless contraindicated, ticagrelor should always be given with a daily low maintenance dose of aspirin 75 mg to 150 mg. There are limited data on the efficacy and safety of ticagrelor beyond 3 years of extended treatment.

Adverse effects:

  • ticagrelor is contraindicated in patients with active pathological bleeding, a history of intracranial haemorrhage, or severe hepatic impairment
  • co-administration of ticagrelor with a strong CYP3A4 inhibitor (for example, ketoconazole, clarithromycin, nefazodone, ritonavir or atazanavir) is also contraindicated
  • most commonly reported adverse effects include dyspnoea, epistaxis, gastrointestinal haemorrhage, subcutaneous or dermal bleeding, and bruising
  • for full details of adverse reactions and contraindications, see the summary of product characteristics


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