Antiplatelet regime changes for patients with a STEMI who require and are directly transferred to PPCI

Clinical Instruction

Following a review of evidence and engagement with regional cardiac specialist centres, the Trust is changing the antiplatelet regime for patients with a STEMI who require and are directly transferred to PPCI.

Clopidogrel will be replaced in drug bag pouches with a new drug called Ticagrelor.

This will be phased in on a rolling basis with each area coming online when a new delivery of medications arrives.
Once new pouches arrive, please swap these out and return the old ones.

This is straight swap-and-change in drug type and dose.
The indications are the same as for clopidogrel.

Below is full guidance for use. This will be added to the clinical manual app, but will not be in JRCALC pocketbooks.
Initially the below guidance will be included within the pouches.

Delivery and go live dates:

  • Bedfordshire 28th June 2021
  • Suffolk 30th June 2021
  • Hertfordshire 5th July 2021
  • Essex 7th July 2021
  • Cambridgeshire 13th July
  • Norfolk and HART 15th July

Clinical guideline for Ticagrelor: Published June 2021


90mg orodispersibale tablets


180mg - 2x 90mg dissolved in mouth and swallowed


Acute ST-elevation myocardial infarction indicated for transfer to PPCI secondary to administration of aspirin



Inhibits platelet aggregation


Known allergy to Ticagrelor

Active bleeding

History of intracranial haemorrhage

Severe hepatic impairment



Unlikely a concern following single dose in an emergency

Asthma, bradycardia (unless pacemaker fitted), COPD, hyperuricaemia, patients at increased risk of bleeding, second- or third-degree heart block (unless pacemaker fitted), sick sinus syndrome (unless pacemaker fitted), moderate hepatic impairment, pregnancy

Side effects

Unlikely following single dose in an emergency

Constipation, diarrhoea, dyspepsia, dyspnoea, gout, gouty arthritis, bleeding, headache, hyperuricaemia, hypotension, nausea, skin reactions, syncope, vertigo.



Angioedema, confusion, intracranial haemorrhage, tumour haemorrhage, thrombotic thrombocytopenic purpura


TICAGRELOR | Drug | BNF content published by NICE


Overview | Ticagrelor for the treatment of acute coronary syndromes | Guidance | NICE


Clinical grade

Paramedic, Nurse, Doctor

If you have any queries, please contact