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

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

Clinical guideline for Ticagrelor: Published June 2021
Presentation	90mg orodispersibale tablets
Dose	180mg - 2x 90mg dissolved in mouth and swallowed
Indications	Acute ST-elevation myocardial infarction indicated for transfer to PPCI secondary to administration of aspirin
Actions	Inhibits platelet aggregation
Contra-indications	Known allergy to Ticagrelor Active bleeding History of intracranial haemorrhage Severe hepatic impairment
Cautions 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. Uncommon: Angioedema, confusion, intracranial haemorrhage, tumour haemorrhage, thrombotic thrombocytopenic purpura
References:	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 clinical.leads@eastamb.nhs.uk.

Downloads

CLINICAL INSTRUCTION CI107- Antiplatelet regime changes 25.06.21 V1.1 (0.27 MB)