TICAGRELOR TAB,ORAL
Clinical Criteria Summary
Exclusion Criteria
- Active pathological bleeding
- Clinically important anemia or thrombocytopenia
- History of intracranial hemorrhage (ICH)
- Severe hepatic impairment
- Increased risk for symptomatic bradycardia events (e.g., sick sinus syndrome, 2nd or 3rd degree atrioventricular block, bradycardia-related syncope not protected by a pacemaker)
- Concomitant simvastatin or lovastatin in doses greater than 40 mg daily
- Concomitant use of strong CYP3A4 inhibitors (e.g., atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole)
- Concomitant use of strong CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine, and phenobarbital)
- Concomitant oral anticoagulant therapy (clopidogrel is preferred P2Y12 inhibitor for use in combination with an oral anticoagulant)
- Anticipated urgent coronary artery bypass graft (CABG) surgery (i.e., within 5 days)
- Receiving concomitant aspirin at a dose of greater than 100 mg daily
Inclusion Criteria
- Acute Coronary Syndromes (ACS) & PCI
- ST-elevation myocardial infarction acute coronary syndrome (STEMI-ACS) undergoing percutaneous coronary intervention (PCI) or receiving no reperfusion
- Non-ST elevation acute coronary syndrome (NSTE-ACS) with at least 2 of the following: ST-segment changes on electrocardiogram indicating ischemia, positive cardiac biomarkers, and/or other high risk feature
- Definite or probable acute stent thrombosis in patients compliant with aspirin and clopidogrel
- Extended Dual Antiplatelet Therapy (DAPT)
- Extended duration dual antiplatelet therapy (DAPT=aspirin plus P2Y12 inhibitor) beyond 12 months following an ACS event as per Cardiology re-evaluation; reduce dose to 60 mg twice daily
- Antiplatelet Resistance or Allergy
- Reduced clopidogrel response (e.g., any documented CYP2C19 intermediate or poor metabolizer phenotypes or high on-treatment platelet reactivity by P2Y12 reaction units [PRU] testing) and continued indication for P2Y12 inhibitor therapy
- Undergoing PCI with or without ACS in patients with clopidogrel or true aspirin allergy
- Stable CAD with Type 2 Diabetes
- Confirmed CAD and type 2 diabetes without prior MI, at particularly high ischemic risk AND low bleed risk given neutral net clinical benefit – restricted to Cardiology
- Cerebrovascular Disease (Stroke/TIA)
- Non-cardioembolic acute ischemic stroke (NIH Stroke Scale score ≤5) or high-risk transient ischemic attack when no other recommended antiplatelet agents are appropriate for use – restricted to Neurology