Help protect against another heart attack

After a heart attack, your risk for another one remains increased, permanently.1

A heart attack is also called acute coronary syndrome or ACS.

One in Five Patients
One in Five Patients

Up to 1 in 5 patients is at risk for a recurrent CV event or death1,2*†

Nearly 50% of Second Heart Attacks Occur at Another Location in Your Coronary Arteries
Nearly 50% of Second Heart Attacks Occur at Another Location in Your Coronary Arteries

If you had a stent put in, your risk is still high. Nearly half of second heart attacks occur at another location in the arteries of your heart—not where you had your stent put in3‡

Key risk factors for another heart attack4

Patient Age Patient age

Medical HistoryMedical history

Health Condition Health conditions

Severity of Heart AttackSeverity of heart attack

Do everything you can to help reduce your risk, including taking medicines as prescribed by your cardiologist.

*The APOLLO HELICON analysis was a retrospective cohort study that included 108,315 patients from a National Swedish registry with a primary diagnosis of acute MI between July 2006 and June 2011. The primary end point was risk of nonfatal MI, nonfatal stroke, or CV death. The cumulative 1-year incidence of the primary end point was 18.3%.1

 

†Data from 6 pooled cardiovascular registries of the National Heart, Lung, and Blood Institute: the Framingham Heart Study, the Atherosclerosis Risk in Communities, the Cardiovascular Health Study, Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study in patients ≥45 years of age, after their first MI from 1995-2012. Incidence in different populations may be higher or lower. From the American Heart Association (AHA) Heart Disease and Stroke Statistics 2022 Update, a publication of statistics on heart disease, stroke, other vascular diseases, and their risk factors from the AHA, Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and other government agencies.2

 

‡The Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study was conducted at 37 sites in the United States and Europe. 697 patients with ACS underwent 3-vessel coronary angiography and grayscale and radiofrequency intravascular ultrasonographic imaging after PCI. Median follow-up was 3.4 years, and 96% of patients underwent stent implantation. Subsequent major adverse CV events (death from cardiac causes, cardiac arrest, MI, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions.3

 

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Risk after a heart attack is high.

REAL-WORLD DATA FROM ACTION REGISTRY-GWTG (Get With the Guidelines)*

Two-year rate: Death, MI, or stroke in patients with STEMI vs NSTEMI4

Alert Icon

Whether you had a heart attack classified as STEMI or NSTEMI, you are at high risk of having another one
Risk Post MI
Risk Post MI
  • Cumulative incidence of death, MI, or stroke in STEMI vs NSTEMI: within the first 90 days: 7.9% vs 8.1%; 90 days to 2 years: 15.2% vs 21.5%; Post discharge to 2 years: 21.9% vs 27.9%.

*The ACTION Registry–Get With the Guidelines (GWTG) is the largest nationwide registry of acute MI in the United States. Patients (N=46,199) were ≥65 years, who presented with either STEMI or NSTEMI to 504 participating hospitals from January 2, 2007 to December 31, 2010, underwent coronary angiography, found to have significant CAD with at least one coronary stenosis in a major epicardial vessel >50%, and had been enrolled in Medicare fee-for-service Parts A and B plans for at least 1 year prior to the index MI hospitalization. Patients who survived the index hospitalization and were discharged to home were included. From hospital discharge through 2 years, the cumulative incidence rates for the composite end point were lower among patients with STEMI compared to those with NSTEMI.

Long-term risk one year after a heart attack

Once you’ve had a heart attack, you remain at risk for having another. Permanently.

Three Out of Four Patients
Three Out of Four Patients

If you have 2 or more risk factors, your risk is even higher. 3 out of 4 patients who had another heart attack had 2 or more risk factors5

Risk factors included5
  • Chronic kidney disease (eGFR 15-89 mL/min/1.73 m2)
  • Multivessel coronary artery disease
  • Diabetes mellitus managed with antidiabetic medicine
  • Age ≥65 years
  • Anemia
  • Chronic lung disease
  • Prior MI (>3 months prior)
  • Peripheral artery disease
  • Left ventricular ejection fraction <40%
  • Cardiac arrest or cardiogenic shock during MI hospitalization

Questions to review with your ACS patients

Review these important topics with patients taking BRILINTA.
  • Do your patients understand their risk of having another heart attack?
  • Do your patients understand why you've chosen their treatment regimen, including their oral antiplatelet?
  • Are your patients aware of how to take their treatment regimen, including their oral antiplatelet?
  • Do they understand how long they may need to take medications, including their oral antiplatelet, and potential reasons for discontinuation?
  • Do they know that it’s important to stay on their treatments for as long as their doctor recommends?
  • Are they aware of what lifestyle modifications they need to make, such as diet, exercise, cardiac rehabilitation, and management of comorbidities?
  • Are your patients aware of the possible side effects of their medications, including their oral antiplatelet?
  • Do your patients understand the importance of talking to other physicians about the medications they are taking, including their oral antiplatelet?
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ACS=acute coronary syndrome; CAD=coronary artery disease; CV=cardiovascular; eGFR=estimated glomerular filtration rate; MI=myocardial infarction; NSTEMI=non–ST-elevation myocardial infarction; STEMI=ST-elevation myocardial infarction.

References
  1. Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163-1170.
  2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation. 2022;145(8):e153-e639.
  3. Stone GW, Maehara A, Lansky AJ, et al; PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364(3):226-235.
  4. Vora AN, Wang TY, Hellkamp AS, et al. Differences in short- and long-term outcomes among older patients with ST-elevation versus non-ST-elevation myocardial infarction with angiographically proven coronary artery disease. Circ Cardiovasc Qual Outcomes. 2016;9(5):513-522.
  5. Spertus J, Bhandary D, Fonseca E, et al. Contemporary incidence of recurrent cardiovascular events 1 to 3 years after myocardial infarction: longitudinal US analysis from NCDR registries linked with all-payer claims database. Presented at: The American College of Cardiology 67th Annual Scientific Session & Expo; Orlando, FL; March 12, 2018.
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IMPORTANT SAFETY INFORMATION FOR BRILINTA® (ticagrelor) 60-MG AND 90-MG TABLETS

WARNING: BLEEDING RISK

  • BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding
  • Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
  • Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery
  • If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

CONTRAINDICATIONS

  • BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

WARNINGS AND PRECAUTIONS

  • Dyspnea was reported more frequently with BRILINTA than in patients treated with control agents. Dyspnea from BRILINTA is often self-limiting
  • In patients being treated for coronary artery disease, discontinuation of BRILINTA will increase the risk of MI, stroke, and death. When possible, interrupt therapy with BRILINTA for 5 days prior to surgery that has a major risk of bleeding. If BRILINTA must be temporarily discontinued, restart as soon as possible
  • Ticagrelor can cause ventricular pauses. Bradyarrhythmias including AV block have been reported in the post-marketing setting. Clinical trials excluded patients at increased risk of bradyarrhythmias not protected by a pacemaker, and they may be at increased risk of developing bradyarrhythmias
  • Avoid use of BRILINTA in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients
  • Central sleep apnea (CSA) including Cheyne-Stokes respiration (CSR) has been reported in the post-marketing setting in patients taking ticagrelor, including recurrence or worsening of CSA/CSR following rechallenge
  • In patients with Heparin Induced Thrombocytopenia (HIT): False-negative results for HIT-related platelet functional tests, including the heparin-induced platelet aggregation (HIPA) assay, have been reported with BRILINTA. BRILINTA is not expected to impact PF4 antibody testing for HIT

ADVERSE REACTIONS

  • The most common adverse reactions (>5%) associated with the use of BRILINTA included bleeding and dyspnea

DRUG INTERACTIONS

  • Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. BRILINTA is metabolized by CYP3A4/5. Strong inhibitors substantially increase ticagrelor exposure and so increase the risk of adverse events. Strong inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor
  • As with other oral P2Y12 inhibitors, co-administration of opioid agonists delays and reduces the absorption of ticagrelor. Consider the use of a parenteral anti-platelet in ACS patients requiring co-administration
  • Patients receiving more than 40 mg per day of simvastatin or lovastatin may be at increased risk of statin-related adverse events
  • Rosuvastatin plasma concentrations may increase because rosuvastatin is a breast cancer resistance protein (BCRP) substrate. Monitor for statin-related adverse effects
  • Monitor digoxin levels with initiation of, or change in, BRILINTA therapy

SPECIAL POPULATIONS

  • Lactation: Breastfeeding is not recommended

INDICATIONS

BRILINTA is indicated to reduce the risk of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction. For at least the first 12 months following ACS, it is superior to clopidogrel. BRILINTA also reduces the risk of stent thrombosis in patients who have been stented for the treatment of ACS.

BRILINTA is indicated to reduce the risk of a first MI or stroke in patients with coronary artery disease (CAD) at high risk for such events. While use is not limited to this setting, the efficacy of ticagrelor was established in a population with type 2 diabetes.

BRILINTA is indicated to reduce the risk of stroke in patients with acute ischemic stroke (NIH Stroke Scale Score ≤5) or high-risk transient ischemic attack (TIA).

DOSING

In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Administer 90 mg twice daily during the first year after an ACS event. After one year administer 60 mg twice daily. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg. However, in patients who have undergone PCI, consider single antiplatelet therapy with BRILINTA based on the evolving risk for thrombotic versus bleeding events.

In patients with CAD but no prior stroke or MI, administer 60 mg twice daily. Generally, use BRILINTA with a daily maintenance dose of aspirin of 75 mg to 100 mg.

In patients with acute ischemic stroke or high-risk TIA, initiate treatment with a 180-mg loading dose of BRILINTA and then continue with 90 mg twice daily for up to 30 days. Use BRILINTA with a loading dose of aspirin (300 mg to 325 mg) and a daily maintenance dose of aspirin of 75 mg to 100 mg.

Please read full Prescribing Information, including Boxed WARNING, and Medication Guide.

You may report side effects related to AstraZeneca products.

 

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