Pioneering anti-clotting drug helps reduce long-term risk for heart attack victims

A pioneering anti-clotting drug will soon be used to further reduce the long-term risks for heart attack patients after being given the thumbs-up from the National Institute for Health and Care Excellence (NICE).

Every day 515 people in the UK will go to hospital with a heart attack.

Around 25 per cent of people who have had a heart attack will go on to have a further heart attack.

NICE is now 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.

Ticagrelor was initially approved by NICE in 2011 after extensive investigations into its effectiveness, led by the University of Sheffield, found it could prevent one in five deaths after heart attack.

Robert Storey, Professor of Cardiology at the University's Department of Infection, Immunity and Cardiovascular Disease, has led UK studies into the benefits of ticagrelor for the past 15 years.

Professor Storey, who is also an Academic Director of the Cardiology and Cardiothoracic Directorate at Sheffield Teaching Hospitals NHS Foundation Trust, recently published evidence showing that a 60mg dose of ticagrelor provides a similar anti-clotting effect to the higher dose of 90mg used in the first year.

"In South Yorkshire, we have been using ticagrelor as our preferred treatment for most heart attack victims over the last four years but have been usually stopping this after one year," said Professor Storey.

The facts

Coronary heart disease is the UK's biggest killer, responsible for 70,000 deaths each year - that's one death every eight minutes

An estimated 915,000 people are alive in the UK today after having survived a heart attack

In the 1960s more than 70 per cent of heart attacks were fatal. Today at least 70 per cent of people survive a heart attack.

"Our recent research shows that prolonged treatment with a 60mg twice-daily dose of ticagrelor beyond this first year provides effective protection against further heart attack or stroke, albeit with an increase in risk of bleeding.

"The provisional approval by NICE for a longer course of treatment opens the way to a new option for managing risk in patients who are at higher risk of further heart attack."

Professor Storey was a member of the international committee that conducted the PEGASUS-TIMI 54 study, a trial of over 21,000 patients around the world.

The results of the PEGASUS-TIMI 54 study were first presented at the American College of Cardiology Congress in 2015, showing that ticagrelor, when added to aspirin, was effective at reducing the risk of fatal or non-fatal heart attack or stroke.

Professor Storey also led a study of 180 patients within the PEGASUS-TIMI 54 trial that demonstrated that ticagrelor 60mg twice daily provides a similar and consistent anti-clotting activity to the 90mg dose of ticagrelor used in the first year after a heart attack, thus providing a rational basis for using this lower dose for long-term treatment.