The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the use of ticagrelor for the treatment of acute coronary syndromes (ACS)(TA 236).

 
NICE advises that ticagrelor in combination with low-dose aspirin is recommended for up to 12 months as a treatment option in adults with acute coronary syndromes (ACS) that is, people:

• with ST-segment-elevation myocardial infarction (STEMI) – defined as ST elevation or new left bundle branch block on electrocardiogram – that cardiologists intend to treat with primary percutaneous coronary intervention (PCI) or
• with non-ST-segment-elevation myocardial infarction (NSTEMI) or
• admitted to hospital with unstable angina – defined as ST or T wave changes on electrocardiogram suggestive of ischaemia plus one of the characteristics defined below. Before ticagrelor is continued beyond the initial treatment, the diagnosis of unstable angina should first be confirmed, ideally by a cardiologist.

Furthermore, NICE states that for the purposes of this guidance, characteristics to be used in defining treatment with ticagrelor for unstable angina are:

• age 60 years or older;
• previous myocardial infarction or previous coronary artery bypass grafting (CABG);
• coronary artery disease with stenosis of 50% or more in at least two vessels;
• previous ischaemic stroke;
• previous transient ischaemic attack, carotid stenosis of at least 50%, or cerebral revascularisation;
• diabetes mellitus;
• peripheral arterial disease; or
• chronic renal dysfunction, defined as a creatinine clearance of less than 60 mL per minute per 1.73 m2 of body-surface area.