heart rhythmLong-term antiplatelet therapy (Brilique) with aspirin can significantly cut the risk of heart attack, stroke or cardiovascular death in patients with a history of heart attack according to the findings of a study of more than 21,000 people.

The current standard care for patients more than one year on from a heart attack is aspirin alone to prevent clotting, however this data from the PEGASUS study by AstraZeneca showed that taking it in combination with Brilique significantly reduced the cardiovascular risk and prevent the one in five that go on to have another heart attack, stroke or even die.

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Commenting on the data, Professor Robert Storey (Professor of Cardiology at the University of Sheffield), said: "Now we have shown, in the PEGASUS study, the potential positive impact of ticagrelor when used more than one year after a heart attack. This is an important advance in our knowledge about how to improve life expectancy in heart attack patients."

The PEGASUS-TIMI 54 study was a large-scale outcomes trial that investigated Brilique™ (ticagrelor) tablets plus low dose aspirin, compared to placebo plus low dose aspirin, for the chronic secondary prevention of atherothrombotic events in patients who had experienced a heart attack one to three years prior to study enrolment.

Key findings from the study, which forms part of the PARTHENON programme [hyperlink], included:
• Both 90mg and 60mg study doses of ticagrelor with aspirin significantly reduced the primary composite endpoint of cardiovascular (CV) death, myocardial infarction (MI) or stroke compared to placebo. The rates at 3 years were 7.85% in the ticagrelor 90mg arm, 7.77% in the ticagrelor 60mg arm, and 9.04% in the placebo arm (Hazard Ratio (HR) for ticagrelor 90mg vs placebo 0.85, 95% CI 0.75 – 0.96, P=0.0080; HR for ticagrelor 60mg vs placebo 0.84, 95% CI 0.74 – 0.95, P=0.0043)
• As expected with an oral antiplatelet and consistent with studies in similar patient populations, TIMI Major Bleeding, the study’s primary safety endpoint, was higher with both doses of ticagrelor plus aspirin compared to placebo plus aspirin
• The primary efficacy endpoint of both doses of ticagrelor appeared consistent across major subgroups including age, sex, index MI type (STEMI/NSTEMI), time from qualifying MI, diabetes, aspirin dose, history of percutaneous intervention (angioplasty), and geographical region
• Intracranial haemorrhage rates at 3 years were 0.56% in the ticagrelor 90mg arm, 0.61% in the ticagrelor 60mg arm, and 0.47% in the placebo arm (HR for ticagrelor 90mg vs placebo 1.44, 95% CI 0.83 – 2.49, p=0.19; HR for ticagrelor 60mg vs placebo 1.33, 95% CI 0.77 – 2.31, p=0.31).

The full findings were presented during the opening late-breaking clinical trial session of the American College of Cardiology’s 64th Annual Scientific Session and Expo.

Further ongoing PARTHENON studies are assessing ticagrelor for the prevention of cardiovascular events in patients with peripheral arterial disease,5 ischaemic stroke or transient ischaemic attack,6 and in patients with diabetes and coronary atherosclerosis.7

Ticagrelor is not approved for secondary prevention of atherothrombotic events in patients with a history of heart attack beyond one year or for the prevention of cardiovascular events in patients with peripheral arterial disease, stroke, diabetes or atherosclerosis.

To read the study results in full go to: www.nejm.org/doi/full/10.1056/NEJMoa1500857?query=featured_home