Rationale for Initiation, Continuation and Discontinuation (RICaD)
Ticagrelor
For preventing atherothrombotic events after myocardial infarction (NICE TA420)
This document supports the use and transfer of an agent which is classified as AMBER.
It is intended for completion by specialist in order to give Primary Care prescribers a clear indication of the reason for
recommending an AMBER medication together with suggested criteria for its subsequent continuation or
discontinuation. This RICaD should be provided as a supplement to the specialist’s clinical letter.
Patient details
Name
NHS
Number
GP details
GP name Dr
GP address
Specialist details
Specialist name
I confirm that this patient is eligible to
receive ticagrelor under the restrictions
listed below
Signature
Date
Contact details
DOB
Patient address
Rationale for Choice
Relevant
Diagnosis:
Agreed indication
for inclusion in
the BSSE APC
formulary:
Adults (18 years and over) who had a myocardial infarction and who are at high risk of a further event.
For specialist initiation by a cardiologist.
Please check boxes below:
Ticagrelor, in combination with aspirin, is recommended within its marketing authorisation as an option for preventing
atherothrombotic events in adults who:
• have had a history of myocardial infarction of at least one year
• and who are at high risk of a further event.
Treatment is usually started without interruption (continuation therapy) after the initial 1-year treatment with ticagrelor 90
mg twice daily (or other adenosine diphosphate (ADP) receptor inhibitor therapy) in such high risk patients.
Treatment should be stopped when clinically indicated or at a maximum of 3 years.
Reason why
ticagrelor has
been chosen in
preference to
drugs without
Formulary
restrictions:
As ticagrelor is an
OPTION, please
indicate any
previous
antiplatelet
therapy
Pre-treatment
test results
Specialists please type text below:
Ticagrelor has been approved, in combination with aspirin, as an option for preventing atherothrombotic events after
myocardial infarction, in line with NICE recommendation. (NICE TA 420).
Previous antiplatelet
Dose
Duration
Reason for stopping
Specialists please complete the information in table below:
Baseline renal and hepatic function:
Parameter
Renal function
Liver function tests including ALT
and AST (if applicable)
2
Baseline results
eGFR- mL/min/1.73 m
ALT
AST
Other:
Birmingham, Sandwell, Solihull and environs Area Prescribing Committee (BSSE APC). Based on HEFT RICaD template
Ticagrelor post MI RICaD
Date Approved: March 2017
Review date: March 2020
1
Guidance on initiation (to be completed by the specialist)
Initiation dose:
Ticagrelor 60 mg twice daily is the recommended dose when an extended treatment is required for patients with a
history of MI of at least one year and a high risk of an atherothrombotic event.
Treatment may be started without interruption as continuation therapy after the initial one-year treatment with
ticagrelor 90 mg or other adenosine diphosphate (ADP) receptor inhibitor therapy in ACS patients with a high risk of an
atherothrombotic event.
Treatment can also be initiated up to 2 years from the MI, or within one year after stopping previous ADP receptor
inhibitor treatment.
There are limited data on the efficacy and safety of ticagrelor beyond 3 years of extended treatment.
If a switch is needed, the first dose of ticagrelor should be administered 24 hours following the last dose of the other
antiplatelet medication
Date ticagrelor 60mg twice daily started: ……………….
Specialist
recommendations
Specialist to complete
Monitoring:
Renal Function to be monitored ONE month after initiation.
The GP is responsible for doing this.
GP to refer to consultant cardiologist if any changes occur with renal function.
Suggested Criteria for Continuation or Discontinuation (to be completed by the specialist)
Frequency
Location
Method
Continuation
Criteria
Review
Discontinuation
Criteria
Assessment of Efficacy
At routine cardiology outpatient appointment
During admission and on review in OPD.
Routine outpatient clinical review as already occurs.
To continue as tolerated by the patient for up to 3 years from date of initiation.
•
Follow up action
Severity of side effects or intolerance to the medication.
o Main reported side effects include dyspnoea, epistaxis, gastrointestinal haemorrhage,
subcutaneous or dermal bleeding, bruising.
o Less common: nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, gastritis, dizziness,
headache, rash, pruritus.
• 3 year course completed.
Specialist to complete
Shared Care Read
Code
In the patient’s notes, using the appropriate Read Code listed below, denote that the patient is receiving treatment
under a shared care agreement/RICaD
GP Prescribing System
Read Code
Description
EMIS and Vision
8BM5.00
Shared care prescribing
SystmOne
XaB58
Shared care
References
SmPC Ticagrelor (Brilique®)
NICE TA 420
Please note the information included in this document is correct at the time of writing.
The manufacturer’s Summary of Product Characteristics (SPC) and the most current edition of the British National Formulary should
be consulted for up to date and more detailed prescribing information.
Birmingham, Sandwell, Solihull and environs Area Prescribing Committee (BSSE APC). Based on HEFT RICaD template
Ticagrelor post MI RICaD
Date Approved: March 2017
Review date: March 2020
2