Bleeding Risk; Aspirin and Brilinta Effectiveness

Bleeding Risk

• Ticagrelor, like other antiplatelet agents, can cause significant, sometimes fatal, bleeding.
• Do not use ticagrelor in patients with active pathological bleeding or a history of intracranial hemorrhage.
• Do not start ticagrelor in patients planned to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue ticagrelor at least 5 days prior to any surgery.
• Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of ticagrelor.
• If possible, manage bleeding without discontinuing ticagrelor. Stopping ticagrelor increases the risk of subsequent cardiovascular events.

Aspirin Dose and Reduced Ticagrelor Effectiveness

• Maintenance doses of aspirin above 100 mg reduce the effectiveness of ticagrelor and should be avoided. After any initial dose, use with aspirin 75 to 100 mg per day.