Home

NICE guidelines clopidogrel

Clopidogrel and modified-release dipyridamole for - NIC

PPT - Perioperative Care PowerPoint Presentation, free

Atrial fibrillation: Aspirin and clopidogrel. Aspirin and clopidogrel. Last revised in May 2021. Aspirin and clopidogrel. Aspirin and clopidogrel. See the CKS topic on Antiplatelet treatment for detailed prescribing information on aspirin and clopidogrel The GDG felt that, where possible, each drug should be considered separately, particularly aspirin and clopidogrel, and that the reference standard should include CT head scan and a follow-up period of sufficient duration to capture delayed bleeding, for example, at 7 days and 1 month NICE recommends clopidogrel as the most cost-effective antiplatelet for secondary prevention of stoke [ NICE, 2010a ], however, clopidogrel is not licensed for use after a TIA [ ABPI, 2018a ], so NICE recommends treatment with modified-release dipyridamole plus aspirin as the preferred treatment option for TIA [ NICE, 2010a ]

The managing intermittent claudication in people with peripheral arterial disease path for the lower limb peripheral arterial disease pathway Do not prescribe clopidogrel to people with: Active pathological bleeding, such as peptic ulcer or intracranial haemorrhage

Algorithm for dual antiplatelet therapy (DAPT) in patients

Clopidogrel — omeprazole and esomeprazole reduce the antiplatelet effect of clopidogrel, and concomitant use should be avoided. The other PPIs may also reduce the efficacy of clopidogrel, and this risk should be weighed against the potential benefit of the PPI [ MHRA, 2010 ] The NICE guideline tells us that any head injured patient who loses consciousness or has any amnesia and has a coagulopathy should have a CT scan. Most of us would be even more conservative than this - and would go as far as to suggest that any anticoagulated patient with a minor head injury should have a CT scan offer clopidogrel instead of aspirin to people who also have other clinical vascular disease, in line with the NICE technology appraisal guidance on clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events, and who have: had an MI and stopped dual antiplatelet therapy or had an MI more than 12 months ag Summary of NICE guidance for Clopidogrel and MR dipyridamole for prevention of occlusive vascular events / Prucalopride in women / Sedation in children and young people. Source: Specialist Pharmacy Service (Add filter) 02 November 2020. This edition of NICE Bites reflects current NICE guidance (as at November 2020) Clopidogrel is used for the prevention of atherothrombotic events in patients with a history of symptomatic ischaemic disease (e.g. ischaemic stroke). In patients with non-ST elevation acute coronary syndromes, clopidogrel, should be given for three months in addition to long-term low-dose aspirin

About clopidogrel - NIC

  1. Patients prescribed clopidogrel/ticagrelor as monotherapy for secondary prevention should continue perioperatively if the risk of bleeding is low. Aspirin may be a suitable alternative if there are no contraindications
  2. The following are key points to remember about the updated guideline on duration of dual antiplatelet therapy (DAPT) in patients with coronary artery disease (CAD): The scope of this focused update is limited to addressing recommendations on duration of DAPT (aspirin plus a P2Y 12 inhibitor) in patients with coronary artery disease (CAD)
  3. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation)
  4. Following a transient ischaemic attack or an ischaemic stroke (not associated with atrial fibrillation), long-term treatment with clopidogrel [unlicensed in transient ischaemic attack] is recommended
  5. 1.1 Scope of the Guidance While there are a number of existing guidelines for the treatment of dental patients taking warfarin 2-4 or aspirin4,5, national dental clinical practice guidelines addressing the newer medications are lacking.6 This guidance aims to encourage a consistent approach to the management of denta

Re: Early management of head injury: summary of updated NICE guidance. Immediate CT scan in the coagulopathic elderly with a minor brain injury is a must. Dear Madam, The NICE head injury guidelines 2014 now consider the use of warfarin alone, as an indication for CT-head scan (CT) within 8 hours, after a minor brain injury (GCS >12) Advisory guidance when to initiate PPIs with antiplatelet therapy / Approved: March 2019 / Review date: March 2021 Page 3 of 3 4. MHRA Clopidogrel and proton pump inhibitors: interaction—updated advice December 201 Clopidogrel and proton pump inhibitors: interaction—updated advice. In light of the most recent evidence, the previous advice on the concomitant use of clopidogrel with proton pump inhibitors. Clopidogrel, should also be given. Prasugrel, is an alternative to clopidogrel in certain patients undergoing percutaneous coronary intervention (see NICE guidance). Ticagrelor, is also an alternative to clopidogrel (see NICE guidance) The National Institute for Health and Clinical Excellence (NICE) guideline on the management of type 2 diabetes, prepared by the Royal College of Physicians (RCP), 1 was the subject of a conference at the College in June 2008. This report highlights some themes of that meeting, concentrating on where aspects of cardiovascular risk management differ from non-diabetic people, on specific.

Fluvoxamine. Both clopidogrel and fluvoxamine can increase the risk of bleeding. Fluvoxamine is predicted to decrease the efficacy of clopidogrel. Manufacturer advises avoid. Severity of interaction: Severe. Evidence for interaction: Theoretical For people who have had a myocardial infarction, this guidance follows on from the recommendations for clopidogrel in combination with low-dose aspirin from NICE (linked item). 1) clopidogrel is recommended as an option to prevent occlusive vascular events Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (NICE technology appraisal guidance 90) Heart . 2011 Apr;97(7):585-6. doi: 10.1136/hrt.2010.219717

The NICE appraisal recommended that treatment with clopidogrel in combination with low-dose aspirin should be continued for up to 12 months after the most recent episode of non-ST-segment-elevation ACS PharmacoEconomics & Outcomes News 619 - 8 Jan 2011 Final guidance on clopidogrel and dipyridamole from NICE NICE has published final guidance of the use of clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events . This guidance updates previous NICE guidance published in 2005. NICE recommends that clopidogrel be used to treat patients who have had an.

Aspirin (or clopidogrel) was formerly rec-ommended for those over the age of 50 years and for the under-50s with cardio-vascular risk factors. These drugs now have no role in the primary prevention of cardiovascular disease in people with type 2 diabetes. NICE's 2014 guideline on assessing and reducing cardiovascu NICE guidelines (Table 2) To avoid stent thrombosis, these patients are in need of long-term treatment with antiplatelet drugs such as clopidogrel and aspirin. 98,99 Subsequently, there is a clinical problem for orthopaedic and trauma surgeons of how to manage patients on these antiplatelet drugs who require surgery. 97

Clopidogrel in the treatment of non-ST-segment - NIC

  1. Guidance produced by the National Institute for Health and Clinical Excellence (NICE) in the UK currently recommends co-prescribing PPIs with aspirin in patients who are at high risk of acute GI bleeds but makes no recommendation regarding PPI prophylaxis in high risk patients on clopidogrel
  2. The following draft guidelines are recommendations to guide decisionmaking with regard to antiplatelet - agents in the perioperative period. They are only guidelines, and clinical judgement must be exercised based on the patient's clinical state and surgical situation. Management of perioperative antiplatelet medications is patient specific
  3. Post Stroke: NICE (2010) recommends the use of clopidogrel monotherapy post-stroke.1 Clopidogrel monotherapy should be started when the initial course of aspirin therapy finishes. Post TIA: T he Royal College of Physicians (2012) has recommended the use of clopidogrel
  4. Clopidogrel prasugrel ticagrelor Fig.1 Guidelines for the management of patients on P2Y12 receptor antagonist antiplatelet agents undergoing endoscopic procedures. Veitch Andrew M et al. Endoscopy in patients Endoscopy 2016; 48: 1-18 Guideline
  5. NICE Multiple Technology Appraisal Guidance No 210 Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (review of technology appraisal 90) Finally, an easy to read summary of the appraisal, called understanding NICE guidance is published on the NICE website to provide information for patients and.

The combination of anticoagulant and antiplatelet therapy is more effective than antiplatelet therapy alone for the initial and long-term management of acute coronary syndromes but increases the risk of bleeding. Antiplatelet therapy is often combined with oral anticoagulants in patients with an ind Offer clopidogrel instead of aspirin to people who also have other clinical vascular disease, in line with the NICE technology appraisal guidance on clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events, and who have: had an MI and stopped dual antiplatelet therapy or; had an MI more than 12 months ago

Aspirin alone Clopidogrel, dipyridamole, prasugrel or ticagrelor single or dual therapy (in combination with aspirin) Vitamin K antagonist (Section 5) Antiplatelet drug(s) (Section 6) Warfarin, acenocoumarol or phenindione Novel Oral Anticoagulant (NOAC) (Section 7) Dabigatran, apixaban or rivaroxaban General Advice (Section 4 The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For. Transient ischaemic attack: clopidogrel - evidence summary (ESUOM23) Source: National Institute for Health and Care Excellence - NICE (Add filter) 13 December 2013. Summary of the evidence on clopidogrel for treating transient ischaemic attack (TIA) to inform local NHS planning and decision-making. Type NICE guidance - clopidogrel following myocardial infarction (MI) risk of bleed with aspirin and clopidogrel: interaction between clopidogrel and proton pump inhibitors (PPI ) antiplatelet therapy (aspirin or clopidogrel) for people already on anticoagulation who have had PCI: MATCH (Management of ATherothrombosis with Clopidogrel in High-risk.

CLOPIDOGREL Drug BNF content published by NIC

Efficacy and safety of clopidogrel only vs. clopidogrel added proton pump inhibitors in the treatment of patients with coronary heart disease after percutaneous coronary intervention: A systematic review and meta-analysis However, the recently published NICE guidelines recommending the use of clopidogrel for preventing ischaemic stroke as well as multivascular disease are immensely helpful, and should encourage us to use this particular antiplatelet agent more aggressively for such patients NICE has produced resources to help implement its guidance on: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. Stroke rehabilitation in adults. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition

NICE Antiplatelet Guideline TA210, December 2010. For the long-term prevention of ischaemic events after stroke or TIA, use clopidogrel monotherapy, 75mg daily. If intolerant of clopidogrel, then use the combination of aspirin 75mg daily plus dipyridamole MR 200mg twice daily, or dipyridamole monotherapy if also intolerant of aspirin We conclude that international guidelines and NICE approval have led to increasing levels of P2Y12 inhibition in ACS patients in this UK centre between May 2010 and February 2013. Ticagrelor was associated with significantly greater P2Y12 inhibition than both clopidogrel and prasugrel during maintenance therapy Peripheral artery disease [clopidogrel 75 mg daily is the preferred antiplatelet but if contraindicated give low-dose aspirin] NICE offer guidance for antiplatelet therapy in people with a separate indication for anticoagulant therapy in their NICE (NG185) Acute coronary syndromes guidelines So NICE guidelines now recommend prasugrel as the first line antiplatelet in the management of acute coronary syndromes in STEMI, over ticagrelor and clopidogrel. And I think this is very much in.

The rate of hematoma complications was highest in the group of patients on aspirin at the time of the procedure (0.7%). Aspirin or clopidogrel, or both, did not meaningfully increase hemorrhagic complications in patients undergoing lumbar punctures, regardless of when the antiplatelet drug was discontinued relative to the time of the procedure guideline for stroke (RCP 2016) are in line with the practice recommendations in the NICE clinical guideline and the options for treatment recommended in the NICE technology appraisal. The only exception is that clopidogrel is recommended as first-choice longer-term prophylaxis after TIA ahead of modified-release dipyridamole plus aspirin. The. NICE looked at the evidence for the efficacy and safety of early aspirin, prior to someone being seen by an expert. National Institute for Health and Care Excellence. Evidence review for aspirin. NICE guideline NG128 intervention evidence review It's worth pointing out that the guidelines for patients on warfarin do specify within 8 hours of the head injury (or immediately if 8 hours has already elapsed), rather than just within 8 hours of presentation to the ED. Reply. Imaging in Paediatric Trauma - RCR Guidelines September 15, 2014 at 4:56 pm To the Editor: The recent editorial in Heart by Fox and Mclean concludes 'The NICE guidance on chest pain provides a series of important advances over the current status of investigation and triage of chest pain and should be welcomed by the profession'.1 One of the key recommendations of the recently published National Institute for Health and Clinical excellence (NICE) guidelines for the.

This guidance should be considered as one part of the wider therapeutic management of patients. The NICE CG167 July 2013. Myocardial infarction with ST segment Elevation: The acute management of Combination of OAC + clopidogrel 75 mg/day or dual antiplatelet therapy consisting of aspirin 75-mg/day and clopidogrel 75 mg/day may b Summary of antiplatelet options in cardiovascular disease. The guidance does NOT override the individual responsibility of healthcare professionals to make decisions appropriate t #### What you need to know New evidence and developments regarding the management of blood glucose levels, antiplatelet therapy, and erectile dysfunction prompted this update of the 2009 guidance. There were safety concerns surrounding some blood glucose lowering medicines, new evidence on new dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, new.

the recommendations in relevant NICE guidance, including TAG 210 (Vascular disease - clopidogrel and dipyridamole)1, TAG 182 (Acute coronary syndrome - prasugrel)2 and TAG 236 (Ticagrelor for acute coronary syndrome)3, the North East Cardiovascular Networ Everything NICE has said on triage, assessment, investigation and management of head injury in infants, children and adults in an interactive flowchar Stroke NICE 2017. 1. Acute strokAcute strokee NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. NICE Pathways are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this pathway see: http. Posted on November 18, 2019 November 18, 2019. Perioperative Anticoagulation and Antiplatelet Guideline. Algorithm for Aspirin. Algorithm for ADP Receptor Antagonists. Algorithm for Dual Antiplatelet Therapy. Algorithm for Warfarin. Algorithm for Direct Oral Anticoagulants (DOAC's) Algorithm for heparins (IV unfractionated heparin and LMWH.

Transient ischaemic attack: clopidogrel - NIC

Focused update on Dual Antiplatelet Therapy (DAPT) Guidelines ESC Clinical Practice Guidelines Topic(s): Myocardial Disease. Cardiovascular Pharmacotherapy. Acute Coronary Syndromes. Guidelines version available to download Full text. Published in 2017 Reference European Heart Journal, Volume 39, Issue 3, 14 January 2018, Pages 213-260, https. Everything NICE has said on secondary prevention and rehabilitation following acute coronary syndromes in an interactive flowchar Clopidogrel bisulfate is an antiplatelet agent used to prevent ischaemic events in patients with vascular disease. Current guidelines recommend withholding clopidogrel for 7 days pre-operatively. However these are not based on orthopaedic patients. We therefore decided to survey current orthopaedic practice to see whether this complied with available clinical data Lumbar puncture (LP) is an important and frequently performed invasive procedure for the diagnosis and management of neurological conditions. There is little in the neurological literature on the topic of periprocedural management of antithrombotics in patients undergoing LP. Current practice is therefore largely extrapolated from guidelines produced by anaesthetic bodies on neuraxial.

Type 2 diabetes in adults latest NICE guidelines - DrPPT - Drug treatment in secondary prevention of stroke

Summary of NICE guidance for Clopidogrel and MR

  1. Guidelines for anticoagulation apply to paroxysmal, persistent and permanent AF and atrial flutter. Do not use this guideline for patients with significant structural heart disease, congenital heart disease or cardiomyopathy. Do not offer aspirin or clopidogrel monotherapy solely for stroke prevention to patients with AF
  2. The decision to use prasugrel as a first-line P2Y 12 inhibitor in the National Institute for Health and Care Excellence (NICE) guideline was based largely on network meta-analysis of trials comparing prasugrel with clopidogrel, and ticagrelor with clopidogrel, and the ISAR-REACT 5 trial, which compared prasugrel directly with ticagrelor [30,31]
  3. or stroke or high-risk TIA within 24 hours of onset7

Antiplatelet treatment Health topics A to Z CKS NIC

During the follow-up period, 76% of patients in the prasugrel group continued to receive the study drug, as compared with 78% of those in the clopidogrel group (P=0.03). The median duration of. NICE guidance on the investigation of chest pain To the Editor: As a 'jobbing cardiologist', I am grateful for the NICE guidance on the recommend either clopidogrel (despite a very low bleeding risk) or invasive approach, or mandate non-invasive testing despite a 6-month risk of non-fatal MI of 12%. If tha NICE Technology Appraisal Guidance 90 Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular event

PPT - Atrial fibrillation PowerPoint Presentation, free

Aspirin and clopidogrel Prescribing information - CKS NIC

Management of acute upper gastrointestinal bleeding: summary of NICE guidance. Management of acute upper gastrointestinal bleeding: summary of NICE guidance BMJ. 2012 Jun 13;344:e3412. doi: 10.1136/bmj.e3412. Clopidogrel Ticlopidine Aspirin. The National Institute of Clinical Excellence (NICE) guidelines recommends clopidogrel for the prevention and treatment of occlusive vascular events in patients with recent stroke, myocardial infarction, acute coronary syndrome and established peripheral vascular disease . This includes patients who have undergone percutaneous coronary.

Head injury: assessment and early management NIC

NICE updates antiplatelet guidance. Clopidogrel and diypridamole inhibit platelet activation, preventing the formation of blood clots | SPL. Sign in to continue. Sign In. Email address. Password. Stay signed in. Trouble signing in? Reset password: Click here 9 Recommendations for platelet inhibition in NSTE-ACS 2015 Recommendations Class Level Oral antiplatelet therapy A P2Y 12 inhibitor is recommended, in addition to aspirin, for 12 months unless there are contraindications such as excessive risk of bleeds. •Ticagrelor (180 mg loading dose, 90 mg twice daily) is recommended, in the absence of contraindicationsd, for al SIGN 129 is in agreement with NICE guidance that there is no advantage in the use of clopidogrel over aspirin for peripheral arterial disease; 2,5 and also with the Prevention Regimen For Effectively Avoiding Second Strokes (PRoFESS) trial that no advantage is seen for clopidogrel monotherapy in people with an ischaemic stroke, over the. Development of the guidance. Prasugrel was considered under the NICE single technology appraisal process.2 In this process, the manufacturer provides an evidence submission, which comprises a report (structured according to a template set by NICE) and economic model. The structured report sets out the evidence base for the drug, and the economic model assesses its cost-effectiveness compared.

Antiplatelet treatment: Scenario - CKS NIC

Managing intermittent claudication in - NICE Pathway

12 TRITON-TIMI 38: Efficacy and safety in an exploratory

clopidogrel and omeprazole Search results page 1 - NIC

Summary of NICE guidance for Clopidogrel and MR dipyridamole for prevention of occlusive vascular events / Prucalopride in women / Sedation in children and young people. This edition of NICE Bites reflects current NICE guidance (as at November 2020). Please go to NICE to check for any recent updates to thi Aspirin or clopidogrel alone did not increase risk. This was a large, multicenter prospective study of adult patients with blunt head trauma requiring CT, comparing those without anticoagulation or antiplatelet agents to those with them. They enrolled 9,070 patients. Relative risk for significant intracranial injury on CT, such as bleeding. Clopidogrel is an inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y 12 class of ADP receptors on platelets. Pharmacodynamics. Clopidogrel must be metabolized by CYP450 enzymes to produce the active metabolite that inhibits platelet aggregation CURE, Clopidogrel, and Aspirin: Good Study, Nice Adjunct, and the Real Deal. Abstract & Commentary. Source: Peters RJ, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study.Circulation 2003;108:1682-1687

HEART FAILURE- EXAM 2

Proton pump inhibitors (PPIs) Prescribing - CKS NIC

Currently recommended by the NICE guidelines for the treatment of STEMI 4 and NSTEMI 7; however, the European Society of Cardiology guidelines only recommend clopidogrel if prasugrel or ticagrelor are not available or contraindicated 5 Prasugrel Similar with two step metabolism however first step is plasma esterase, second CYP450 The recently published SIGN guidance advises that Clopidogrel alone should not be a delaying factor in operative management of hip fractures. 10 General anaesthesia is advised and platelet transfusion advocated for uncontrollable bleeding. 10 The debate of general versus regional anaesthesia in this high risk group of patients is longstanding.

JC: Clopidogrel + head injury = CT? - St Emlyn

NICE TA317 Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention (July 2014) To be initiated only by a Consultant Cardiologist in line with NICE guidance and also for patients who otherwise would be treated with clopidogrel but who are intolerant / allergic to clopidogrel NEEMMC GUIDELINES FOR TABLET CRUSHING AND ADMINISTRATION VIA ENTERAL FEEDING TUBES KEY TO DRUG ADMINISTRATION GUIDELINES Please follow the guidelines in order, as shown in the chart (i.e. number 1 is the first choice of which form to administer the drug in). A Tablet will disperse in 1-2 minutes. B Tablet will disperse in greater than 2 minutes

NICE guidance - clopidogrel following myocardial

clopidogrel prescribing Search results page 1 - NIC

side effects. Consider PPIs other than omeprazole or esomeprazole in patients who are taking clopidogrel. Other gastrointestinal therapy such as H2 blockers (except cimetidine) or antacids may be more suitable in some patients 5 • Proton Pump Inhibitors (PPIs) NICE Guidance (Management of osteoathritis 2008) suggests the use of low cos Appendix 1 : Treatment guidelines Risk assessment chart — Trauma Trauma injury Treatment guidelines Low risk Moderate risk High risk HIP FRACTURE Enoxaparin 20mg nocte commencing night of admission and continuing until post-operation, at that point increasing to 40mg* nocte for 28 days. If admitted on aspirin and/or clopidogrel, conside NICE TA230 guidance in combination with aspirin and clopidogrel post STEMI; Note: there are different TLS colours for dabigatran depending on the indication. Dabigatran. TLS Green for the prevention of stroke and systemic embolism in patients with Atrial Fibrillation as per NICE TA249 guidanc This guidance is adapted from NICE TA210-Clopidogrel and modified release dipyridamole for the prevention of occlusive vascular events. Antiplatelets and anticoagulation in stroke-Quick reference guide-clinical guideline, v2 Principal author: Geraldine McKerrel The NICE guidance Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (TA 210) link advises that: w Clopidogrel - prescribed as the generic Prasugrel Ticagrelor Dipyridamole 200mg m/r 2.12 Lipid-regulating drugs After an ischaemic stroke: Generic clopidogrel is recommended as first choice

Antiplatelet drugs Treatment summary - NIC

Previous NICE guidance on the use of GPIs was based on an early meta-analysis that demonstrated a reduction in the composite of death and myocardial infarction when used in the treatment of NSTEMI ACS, particularly in patients with a positive troponin test. 16 However, these studies were performed prior to the widespread use of clopidogrel and. Please go to NICE to check for any recent updates to this guideline.. NICE Bites is a monthly prescribing bulletin from the North West Medicines Information Centre that summarises key recommendations from NICE guidance. NICE Bites No 118, May 2019 includes one guideline: Crohn's disease management (NICE NG129). It includes sections on inducing remission and maintaining remission The NICE guideline recommends that anticoagulation should be offered to people with AF who have a CHA 2 DS 2-VASc score of 2 or above, and considered for men with a CHA 2 DS 2 • VKA plus clopidogrel: 1.53, 95% CI 0.93 to 2.52 • VKA plus dual antiplatelet therapy: 1.76, 95% CI 1.05 to 2.9 NICE clinical guideline 172 (November 2013) recommends ticagrelor in combination with low-dose aspirin for up to 12 months as a treatment option in adults with acute coronary syndrome (ACS). 2. INDICATIONS Ticagrelor should be considered for patients with: A new STEMI treated with primary PCI or thrombolytic therap

The investigators will collect data retrospectively on 2500 patients treated with Clopidogrel prior to the guideline change and 2500 treated with Ticagrelor thereafter. The primary end point will be incidence of BARC 3-5 (Bleeding Academic Research Consortium) and PLATO major bleeding Considering the affordability of ticagrelor when used according to NICE guidance Considering the affordability of ticagrelor when used according to NICE guidance Fell, G.; Reynolds, B.; Lindsay, S.; Keegan, T.; Lee, D. 2013-11-01 00:00:00 To the Editor Ticagrelor, in combination with low‐dose aspirin, is licensed and has been approved by National Institute for Clinical and Health Excellence. For people with NSTEMI clopidogrel with aspirin or ticagrelor with aspirin are treatment options. NICE has produced a clinical guideline on secondary prevention in primary and secondary care.