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BRILINTA (Ticagrelor) Receives Additional Class I Recommendation In Updated ACCF/AHA Guidelines For The Management Of STEMI Patients

AstraZeneca (NYSE: AZN) announced today that a combined panel of experts from the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) have updated their guidelines to include a Class I recommendation for use of the oral antiplatelet (OAP) medicine BRILINTA ® (ticagrelor) tablets in patients with ST-elevation myocardial infarction (STEMI) managed invasively. 1 With this latest guidelines update, BRILINTA is included in more than 10 major acute coronary syndrome (ACS) treatment guidelines globally. 1-11

“The U.S. Cardiology community is again acknowledging the clinical value of BRILINTA,” said James Ferguson, MD, Executive Director, Medical Affairs and Strategic Development, US, and Vice President for Global Medical Affairs. “This significant milestone, along with the inclusion in the NSTEMI Guidelines in July, solidifies the position of BRILINTA in multiple ACS guidelines as an important part of standard of care for both STEMI and NSTEMI patients.” 2

A Class I recommendation is the highest recommendation provided by the guidelines committee.

Following are specific Class I and Class IIa recommendations within the guidelines relating to OAPs, including BRILINTA, as well as the use of aspirin (the recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily):

Antiplatelet Therapy to Support Primary Percutaneous Coronary Intervention (PCI) for STEMI: Recommendations

Class I

1. Aspirin 162 to 325 mg should be given before primary PCI. (Level of Evidence (LOE): B)

2. After PCI, aspirin should be continued indefinitely. (LOE: A)

3. A loading dose of a P2Y 12 receptor inhibitor should be given as early as possible or at time of primary PCI to patients with STEMI. Options include:

a. Clopidogrel 600 mg (LOE: B); or

b. Prasugrel 60 mg (LOE: B); or

c. Ticagrelor 180 mg (LOE: B)

4. P2Y 12 inhibitor therapy should be given for 1 year to patients with STEMI who receive a stent (bare-metal stent [BMS] or drug-eluting stent [DES]) during primary PCI using the following maintenance doses:

a. Clopidogrel 75 mg daily (LOE: B); or

b. Prasugrel 10 mg daily (LOE: B); or

c. Ticagrelor 90 mg twice a day (LOE: B)

Class IIa

1. It is reasonable to use 81 mg of aspirin per day in preference to higher maintenance doses after primary PCI. (LOE: B)

2. It is reasonable to begin treatment with an intravenous GP IIb/IIIa receptor antagonist such as abciximab (LOE: A), high-bolus-dose tirofiban (LOE: B), or double-bolus eptifibatide (LOE: B) at the time of primary PCI (with or without stenting or clopidogrel pre-treatment) in selected patients with STEMI who are receiving unfractionated heparin (UFH).

BRILINTA Indication

BRILINTA is indicated to reduce the rate of thrombotic cardiovascular (CV) events in patients with acute coronary syndrome (ACS: unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). BRILINTA has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI), or stroke compared to clopidogrel. The difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis.

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