Ticagrelor (Brilinta) Tablet Uses in Pakistan

Ticagrelor (Brilinta) is a widely prescribed antiplatelet medicine in Pakistan for ACS and after coronary stent placement. This guide covers all approved uses, the DAPT protocol, and essential information.

Compiled by the PakVita Editorial Team · AI-assisted drafting with editorial review · Sourced from DRAP, WHO, BNF · Last updated: 2026-06-17

Uses

Quick Answer

Ticagrelor (Brilinta) is an antiplatelet medicine. It is used in Acute Coronary Syndrome (ACS — heart attack / unstable angina), after coronary stent (PCI), established high-risk CAD (60mg dosing), and Peripheral Arterial Disease (PAD) in DAPT with aspirin. After ACS/stent, NEVER stop without the doctor's explicit permission — stent thrombosis risk is life-threatening.

Primary Uses at a Glance

Acute Coronary Syndrome (ACS) — Heart Attack / Unstable Angina

In ACS, platelets rapidly form clots that block coronary arteries. Ticagrelor blocks the P2Y12 receptor — inhibiting platelet aggregation. Used in DAPT with aspirin at 90mg twice daily. It is more potent than clopidogrel and has a faster onset — major trials (PLATO) showed better outcomes.

On cardiologist's prescription — as soon as possible after ACS diagnosis; initiated in hospital

Post-PCI (Coronary Stent Placement)

After coronary stent placement (PCI — Percutaneous Coronary Intervention), stent thrombosis is a life-threatening risk. Ticagrelor + aspirin DAPT dramatically reduces this risk. Standard duration: bare-metal stent 1 month, drug-eluting stent 12 months DAPT — cardiologist decides. Stopping ticagrelor during this period is DANGEROUS.

Post-PCI on cardiologist's prescription — duration based on stent type and bleeding risk

Established CAD at High Cardiovascular Risk (60mg dosing)

The PEGASUS-TIMI 54 trial showed that patients who had an MI more than 1 year ago and have high CV risk factors benefit from ticagrelor 60mg BD + aspirin (secondary prevention). This is a different indication from 90mg — cardiologist specifically prescribes 60mg in the chronic phase.

On cardiologist's prescription — 60mg BD dosing; for high-risk CAD patients

Peripheral Arterial Disease (PAD)

In PAD, atherosclerosis affects peripheral arteries — reducing blood supply to the legs. Ticagrelor + aspirin is used to reduce peripheral CV events. This DAPT protocol is guided by a vascular surgeon or cardiologist.

On prescription from a vascular specialist or cardiologist — for established PAD

Other Uses

Secondary prevention after MI in high-risk patients (PEGASUS trial — 60mg)
Stroke prevention in high-risk atherosclerotic disease patients (specialist-guided)

Ticagrelor (Brilinta) Tablet Uses (Fayde / Kis kaam aata hai)

Ticagrelor tablet contains Ticagrelor and belongs to the Antiplatelet (P2Y12 Receptor Antagonist) group. Below are all approved and common uses in Pakistan in detail.

Primary Uses (Mukhya Istemal)

Acute Coronary Syndrome (ACS) — heart attack (NSTEMI/STEMI) or unstable angina — DAPT with aspirin (90mg BD)
Post-PCI / Stent — stent thrombosis prevention after coronary stent placement
Established high-risk CAD — secondary prevention in patients >1 year post-MI (60mg BD — PEGASUS trial)
Peripheral Arterial Disease (PAD) — with aspirin

CRITICAL: Abrupt Stopping Warning

> After ACS or coronary stent, ticagrelor must NEVER be stopped abruptly — without the doctor's explicit permission. Stent thrombosis can occur — this is life-threatening.

DAPT Protocol (Dual Antiplatelet Therapy)

Indication	Ticagrelor Dose	Aspirin Dose	Duration
ACS (NSTEMI/STEMI)	90mg twice daily	75-100mg once daily	Minimum 12 months
Post-PCI (drug-eluting stent)	90mg twice daily	75-100mg once daily	12 months
Chronic high-risk CAD	60mg twice daily	75-100mg once daily	Long-term (specialist-guided)
PAD	90mg or 60mg twice daily	75-100mg once daily	Specialist-guided

Ticagrelor vs Clopidogrel

Clopidogrel is more common and cheaper in Pakistan — but ticagrelor offers:

No non-responder problem
Faster onset (more rapid platelet inhibition)
Higher potency
Reversible binding

Downside: more expensive, dyspnoea side effect, limited generic availability in Pakistan.

Who Should Take It (Kin logon ke liye)

Hospitalized patients after ACS (cardiologist prescription)
After coronary stent (PCI)
High-risk CAD patients (cardiologist-selected 60mg dosing)
PAD patients (vascular/cardiology specialist)

When NOT to Use Ticagrelor (Kab nahi lena chahiye)

Previous intracranial haemorrhage (CONTRAINDICATED)
Active major bleeding
Severe hepatic impairment
With aspirin >100mg/day
With strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin)

Summary

Ticagrelor is used in antiplatelet therapy with aspirin for ACS, after stent placement, high-risk CAD, and PAD. It is more potent than clopidogrel. In ACS/stent patients, abrupt stopping can be life-threatening — only discontinue with cardiologist's permission.

The information in this guide is for educational purposes only.

Frequently Asked Questions

Ticagrelor kin conditions mein use hoti hai?

Ticagrelor (Brilinta) is used in DAPT with aspirin for ACS (heart attack/unstable angina), after coronary stent placement, high-risk CAD (60mg dosing), and PAD.

Ticagrelor bina prescription ke le sakte hain?

No — ticagrelor is a prescription (Rx) medicine. Taking it without cardiologist supervision is dangerous — incorrect dosing or abrupt stopping can be life-threatening.

Ticagrelor aur clopidogrel mein kya farq hai?

Ticagrelor is a reversible, direct P2Y12 antagonist — no CYP2C19 metabolism needed (no non-responder problem). Clopidogrel is a prodrug — CYP2C19 dependent; cheaper and more widely available in Pakistan. The cardiologist decides which is better.

Ticagrelor kitne time tak leni chahiye?

Usually 12 months after ACS (90mg BD). For chronic CAD, 60mg BD long-term. Duration is always decided by the cardiologist — do not stop on your own.

Kya ticagrelor aur aspirin saath leni chahiye?

Yes — ticagrelor is always taken in DAPT with aspirin (75–100mg/day). The aspirin dose must NOT exceed 100mg — higher doses reduce ticagrelor efficacy.

Sources

DRAP Registered Products Database — Drug Regulatory Authority of Pakistan
WHO Model List of Essential Medicines, 23rd ed. (2023) — World Health Organization
British National Formulary (BNF) — BMJ Group & Pharmaceutical Press

Medical disclaimer

This page is for educational use only and does not replace professional medical advice. Always confirm diagnosis, dose, and interactions with a qualified doctor or pharmacist before starting or changing any medicine.