I’m a stroke expert — the ‘essential 8’ ways to reduce your risk

You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke so, you better start working on it now. This can't guarantee you won't have a stroke, so the more sensible option is to get EXACT 100% RECOVERY PROTOCOLS CREATED!

I’m a stroke expert — the ‘essential 8’ ways to reduce your risk

By 

McKenzie Beard

Published March 22, 2025, 4:00 p.m. ET

estimated 610,000 Americans are expected to experience their firststrokethis year — but you don’t have to be one of them.With nearly 80% of strokes considered preventable, you’d think we’d all be on high alert. But as Siobhan Mclernon found during her time as a nurse in a neurocritical care unit, most people are still in the dark about key risk factors.“Adopting these eight simple lifestyle changes can help to reduce stroke risk and optimize both heart and brain health,” Mclernon, now a senior lecturer in adult nursing at London South Bank University, An estimated 795,000 people in the United States have a stroke each year. A stroke occurs when blood flow to the brain is disrupted or when a blood vessel bursts, causing damage to the brain.fourth leading cause of death in the US, claiming 162,639 lives. It’s also a leading cause of disability worldwide.Explore More While the risk of stroke increases with age, Mclernon said it can happen at any time — and incidents among adults 55 and younger are on the rise. Even more alarming, once you’ve had a stroke, your risk of having another spikes.

Read on to discover Mclernon’s “essential eight” tips for preventing the first one.

Put down the cigarette

People who smoke a pack of cigarettes are six times more likely to have a stroke. 

Smoking increases your stroke risk because the harmful chemicals in tobacco contribute tot he buildup of plaque in your arteries, increasing the risk of blood clots, reducing the amount of oxygen in your blood and making your heart pump harder. 

In 2023, approximately 11% of US adults, or roughly 28.8 million people, were current cigarette smokers. If that’s not enough to get you to quit, know that the people around you breathing in the secondhand smoke are also at an elevated risk. In fact, secondhand smoke exposure causes more than 8,000 deaths from stroke annually, People with this blood type are 16% more likely to have a stroke before the age 60 Get your levels in checkThe American Stroke Association urges healthcare providers to screen for high blood pressure, elevated cholesterol and high blood sugar — each a major player in preventing that first stroke.High blood pressure andhigh blood sugar both weaken blood vessels over time, creating the perfect environment for clots to form and travel to the brain. Meanwhile, high cholesterol leads to the buildup of fatty deposits in your arteries, narrowing and stiffening them, setting the stage for clots that block blood flow to the brain. Individually, each of these risk factors increases your chances of a stroke. But together, the risk soars and so does the likelihood of poor outcomes, including death, disability and recurrent strokes.Stroke is a leading cause of disability around the globe.Studio Romantic – stock.adobe.com

“If you’re over 18 years of age, get your blood pressure checked regularly so, if you do show signs of developing high blood pressure, you can nip it in the bud and make appropriate changes to your lifestyle to help reduce your risk of stroke,” Mclernon said. 

To reduce blood sugar levels, she recommends regular exercise, a balanced diet rich in fiber, staying hydrated, maintaining a healthy weight and managing stress.

See Also

The best medicine

I’m a doctor — don’t delay care if you experience these stroke symptoms

“To lower cholesterol, aim to keep saturated fat — found in fatty meats, butter, cheese, and full-fat dairy — below 7% of your daily calories, stay active and maintain a healthy weight,” Mclernon said. 

Maintain a healthy weight

Being overweight or obese is a major stroke risk factor, increasing the likelihood of a stroke by 22% and 64%, respectively, according to Mclernon. 

But it’s not just about how much extra weight you carry — it’s where you carry it. Belly fat, in particular, can elevate your risk of high blood pressure, diabetes, and other health issues, all of which contribute to a higher stroke risk.

The good news? Losing just 5% to 10% of your starting weight can lower blood pressure and reduce other stroke risk factors, according to Harvard Health. 

Be mindful of what you eat

A balanced diet is one of the best ways to maintain a healthy weight and lower your stroke risk.

Mclernon recommends the Mediterranean diet, with studies showing that a pro-oil, fish, lean protein, and vegetable-focused lifestyle can significantly reduce stroke risk, especially in women.

5

In addition to preventing strokes, the Mediterranean diet has been shown to reduced the risk of heart disease.aamulya – stock.adobe.com

Certain foods can also help tackle other stroke risk factors.

See Also

‘First of its kind’ medication can significantly reduce heart attacks and strokes

For instance, foods rich in potassium — like sweet potatoes, bananas and tomatoes — are great for maintaining healthy blood pressure. And fish such as salmon, albacore tuna and trout can help keep your cholesterol in check.

Keep moving

Federal guidelines recommend that US adults get at least 150 minutes of moderate-intensity physical activity each week, plus muscle-strengthening exercises at least two days a week.

Unfortunately, many of us aren’t hitting the mark. A CDC study found that only 24.2% of adults met both physical activity targets in 2020.

Regular physical activity has been shown to reduce stroke risk by up to 30%, helping lower blood pressure, improve cholesterol levels and stabilize blood sugar. Catch some ZZZs “Too little sleep can lead to high blood pressure,” McClernon explained. “Too much sleep, however, is also associated with increased stroke risk.” For example, one study found that people who sleep nine or more hours a night face a 23% higher stroke risk compared to those getting less than eight hours. Researchers suggest this could be because oversleeping may signal underlying issues like depression or sleep apnea — both of which raise stroke risk.

McClernon recommends aiming for seven to nine hours of sleep each night for optimal health.

Weight Loss Meds Help Stroke Survivors Prevent Stroke Recurrence, Death

 Will your competent? hospital be evaluating this for a post stroke protocol?

Weight Loss Meds Help Stroke Survivors Prevent Stroke Recurrence, Death

Key Takeaways

• Two types of drugs can reduce a stroke patient’s future risk of health emergencies

• GLP-1 weight loss drugs like Ozempic can decrease their risk of heart attack or death

• SGLT2 diabetes meds like Jardiance or Farxiga do the same, and also decrease risk of a follow-up stroke

MONDAY, Nov. 11, 2024 (HealthDay News) -- The weight-loss drug Ozempic can help reduce stroke patients’ risk of a heart attack or death, a new study says.

GLP-1 weight-loss drugs like Ozempic or SGLT2 diabetes medications like Jardiance or Farxiga both helped protect the health of people following a stroke, researchers found.

Patients taking either a GLP-1 or SGLT2 drug had a 74% lower risk of death and an 84% lower risk of a heart attack within an average three years after their stroke, results show.

SGLT2 drugs also were associated with a 67% lower risk of a second stroke, researchers report.

“Unfortunately, a quarter of people who survive a stroke will have another stroke, and they are also at risk for other cardiovascular events such as a heart attack since many of the risk factors of a stroke are also associated with other forms of heart disease,” said lead researcher Dr. Ali Sheffeh, an internal medicine physician and research scholar at the Mayo Clinic in Rochester, Minn.

“Managing these risks, as well as looking at novel approaches to help lower the chances of another stroke, heart attack or death among this population are all critical steps in increasing stroke survival and improving the quality of life for people who have had a stroke,” Sheffeh added in a news release.

For the study, researchers reviewed medical records for more than 7,000 adults treated for strokes caused by blood clots between January 2000 and June 2022 in Minnesota or Wisconsin.

The team looked specifically at the potential benefits that might come from taking either a GLP-1 or SGLT2 drug after a stroke.

GLP-1 drugs help manage diabetes and promote weight loss by mimicking the GLP-1 hormone, which works to control insulin and blood sugar levels, decrease appetite and slow digestion.

SGLT2 drugs lower blood sugar levels by causing the kidneys to filter excess sugar from the body and excrete it in urine, researchers said in background notes.

The death rate among stroke survivors who took either a GLP-1 or SGLT2 drug was under 12%, compared with 54% among patients who didn’t take either drug, researchers found.

The rate of heart attacks among patients taking either medication was 1.5%, compared to 6% among patients taking neither, results show.

“The results of the study are consistent with other research about the preventive role of these medications against cardiovascular disease in people with obesity or heart failure,” Sheffeh said.

American Heart Association stroke expert Dr. Cheryl Bushnell said the findings jibe with what is known about the benefits of the two types of medication.

“For several years now, we have seen from randomized controlled trials that SGLT2 inhibitors and GLP-1 receptor agonists have the ability to reduce the risk of cardiovascular disease, which includes stroke, heart attack and death,” Bushnell, vice chair of neurology research at Wake Forest University School of Medicine in Winston-Salem, N.C., said in a news release.

“These new findings are in line with what we would expect, and we have seen that these outcomes are evident in patients with Type 2 diabetes and obesity and in patients with obesity without Type 2 diabetes,” Bushnell added.

GLP-1 drugs not only promote weight loss, they’ve also been shown to help lower blood pressure and decrease the formation of plaques that clog arteries, Bushnell said. Both are risk factors for heart attack and stroke.

“Another mechanism that could be very important for this current study is that GLP-1 receptor agonists can actually decrease clumping of blood platelets, and that, in itself, could decrease the risk of clotting and lead to a lower risk of stroke,” Bushnell said.

“We need a clinical trial to know whether these SGLT2 inhibitors and GLP-1 receptor agonists could actually change practice, how we can help patients to prevent a second or recurrent stroke,” Bushnell added. “These medications could be really important, however, we just don't have that data yet.”

Researchers presented the findings Monday at the American Heart Association’s annual meeting in Chicago.

Because theses findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.

More information

Johns Hopkins Medicine has more on SGLT2 inhibitors.

SOURCE: American Heart Association, news release, Nov. 11, 2024

What This Means For You

People who have suffered a stroke should ask their doctor if a GLP-1 or SGLT2 medication might help protect their health.

Study links higher omega-3 levels to decreased stroke risk

Did your doctor instruct the dietician to get these into your hospital meals? NO? Then you don't have a functioning stroke doctor!

What foods provide omega-3s?

• Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)

• Nuts and seeds (such as flaxseed, chia seeds, and walnuts)

• Plant oils (such as flaxseed oil, soybean oil, and canola oil)

 

Study links higher omega-3 levels to decreased stroke risk

12-Feb-2024 By Asia Sherman

A new study published in the journal Stroke shows that people with the highest omega-3 levels have a lower risk of stroke. It also dispels correlations between omega-3s and increased risk of brain hemorrhaging.

https://www.nutraingredients-usa.com/Article/2024/02/12/study-links-higher-omega-3-levels-to-decreased-stroke-risk

Video: 4 daily rituals that can cut your risk of stroke

Good ideas.

 Video: 4 daily rituals that can cut your risk of stroke

If your risk of stroke weighs on your mind, there's good news: It's not just age and family history that matter. You can cut your stroke risk by over 50% through daily habits. Watch to learn the most important things you can do daily to move the needle on your stroke risk.

Watch now

4 daily rituals that can cut your risk of stroke

#1: The lunch-hour stroll. Five 30-minute walks at a moderate pace each week can cut your stroke risk by as much as 30%. ( I do 2+ hours walks -5 times a week.)

#2: The happy hour mocktail. Heavy drinking drives up your risk of stroke. Find other ways to celebrate.(Nope, not for me, social drinking(Not heavy) will prevent dementia by extra social connections.)

#3: Two plants at every meal. Each fruit or vegetable you add to your day can cut your risk of stroke by up to 6%. (I'll have to work on this.)

#4: Your 'get-past-the-craving' strategy. New rituals help you stop smoking. And quitting is the single most powerful way to avoid a stroke. (A few cigars when traveling internationally.)

 

These Are The 7 Things Stroke Doctors Say You Should Never, Ever Do

 

These Are The 7 Things Stroke Doctors Say You Should Never, Ever Do

In the United States, strokes are a top cause of death and a major cause of disability, according to the American Stroke Association. This is a scary reality, especially since many of the stroke risk factors are pretty silent (like high cholesterol and high blood pressure) ― until they’re not.

But just because some of the risk factors aren’t always obvious doesn’t mean strokes can’t be controlled. In fact, it’s estimated that 80% of strokes are preventable through lifestyle changes like exercise, diet and more, according to the Centers for Disease Control and Prevention.

No one knows that more than the experts who treat the issue. Stroke doctors say they think a lot about the key ways to lower their risk (and their patients’ risk) of stroke.

“I like to think of it more proactively — what I could do to prevent stroke,” said Dr. Anthony Kim, a vascular neurologist and medical director of the University of California at San Francisco Stroke Center.

Below, stroke doctors share the habits they personally avoid ― and why you should avoid them, too.

Have A Sedentary Lifestyle(I try to get out walking 6-8000 steps 4-6 times a week)

Delmaine Donson / Getty Images

According to Dr. Arthur Wang, director of endovascular neurosurgery at Tulane University School of Medicine, one of the modifiable risk factors for stroke is having a sedentary lifestyle.

While there isn’t one across-the-board definition of a sedentary lifestyle, overall, it means spending too much time sitting or lying down and not enough time exercising or moving around.

“It’s been shown that regular physical activity helps keep your blood vessels clog-free. It stops the buildup of plaque in the arteries,” Wang said. “And so we generally recommend that people get probably 30 minutes of moderate exercise maybe five times a week.”

This could mean going for walks, runs, biking, gardening or joining a group workout class — there is no wrong way to get moving.

Ignore High Blood Pressure(Mine was founf by blood donation and is now under control)

Malaeru Florentina / Getty Images/500px

“It turns out that a lot of the same things that we would recommend for a healthy lifestyle also reduce the risk of both heart disease and stroke,” Kim said. “But if there’s one factor that is the most impactful it would be blood pressure, blood pressure, blood pressure.”

Elevated blood pressure, particularly over time, can lead to problems, he said: High blood pressure is the biggest modifiable stroke risk factor.

“If you took a magic wand and waved it and suddenly eliminated high blood pressure from the U.S. population, there would be 60% fewer strokes,” Kim said. “It’s by far the leading risk factor for stroke and we call it the silent killer because oftentimes, patients don’t feel it; you have to have it checked and monitored and treated.”

Skip Regular Check-Ups(It's better now that I'm retired)

Thomas Barwick / Getty Images

“These risk factors oftentimes don’t have any real symptoms,” Wang said, which is a worrisome thing to think about. “A patient would never know that their blood pressure’s high, they wouldn’t know whether they have high cholesterol unless all of this is routinely tested or screened on a regular basis.”

This means it’s crucial that you visit your primary care doctor for the routine check-ups that they deem necessary. They’ll screen you for issues like high cholesterol and high blood pressure while checking other risk factors like your blood sugar and weight, too, he added.

“I think just being hyper-vigilant about those things, especially when these risk factors for stroke are very cryptic, meaning that they don’t manifest in any real symptoms, so it’s really important for patients to understand that so they take the actionable steps to see their doctor to get these routine screening tests,” Wang said.

Your doctor can also review any risk factors outside your control, like gender (strokes are more common in women, Wang said), race (they’re more common in Black people, he noted) and personal history.

“In terms of previous medical history, those who have had prior strokes in the past, or if one of their parents had a stroke in the past, are at a much higher risk of having a future stroke,” Wang said.

Smoke(Nope)

Oliver Helbig / Getty Images

According to both Kim and Wang, one of the habits that is high on a to-avoid list is smoking.

“That definitely increases the risk of stroke, and heart disease, for that matter,” Kim said.

“And one of the ways that it does that is by causing the blood vessels to become narrowed over time, and that can ultimately lead to blockages in blood flow to part of the brain, which is essentially what a stroke is,” he explained.

Drink Too Much Alcohol(Well my use is vastly increasing my social connections, reducing my risk of dementia)

Yana Iskayeva / Getty Images

You’re probably aware that alcohol is not good for you. It’s linked to certain kinds of cancer, liver disease, and yes, stroke, too. Specifically, Kim said there is an “association between ... excessive alcohol use and heart disease and stroke risk.”

Alcohol recommendations vary by person, but, the CDC considers more than four drinks in one sitting for women or five drinks in one sitting for men to be excessive drinking. More than eight drinks per week for women and 15 drinks per week for men is also considered excessive drinking.

Generally, it’s accepted that women should not have more than one alcoholic drink a day and men should not have more than two, Kim said. These are also the recommendations put forth by the Dietary Guidelines for Americans.

Ignore Your Diet(Since nothing is exact in diet research, I don't worry about this)

Image By Sherry Galey / Getty Images

A proper diet is important for managing stroke risk, too. This means moderating foods that are full of saturated fats, sugar and salt, Wang said. (Additionally, Kim pointed out that there is a relationship between salt intake and high blood pressure, which, as we now know, is another stroke risk factor.)

When it comes to what you should eat, Kim points to the work of author and journalist Michael Pollan. This advice is “eat food, mostly plants, not too much,” Wang said. This means having a diet that’s rich in fruits and veggies with some meat added in.

Dismiss Necessary Treatment(My stroke was extremely obvious)

Fiordaliso / Getty Images

Since strokes are so common in this country (and this world), it’s important that you’re aware of the signs and get treated as soon as possible. Available stroke treatments work better the sooner they’re done, Kim said.

“Because many strokes aren’t painful, and the symptoms of stroke vary so much, it’s important to recognize symptoms of stroke,” he said.

And, there’s a useful acronym to help people remember the signs — and that acronym is FAST, Kim said. FAST stands for “facial drooping, arm weakness, speech difficulty and time to call 9-1-1,” according to the American Stroke Association website.

“These are not the list of all potential stroke symptoms, but any one of those  [factors] raises the suspicion that it could be a stroke, especially if it happens suddenly,” Kim noted.

And, once again, it’s important to remember that getting treatment as fast as possible is vital, he said.This article originally appeared on HuffPost.

Type of shingles vaccine cuts stroke risk by 16% in elderly

Maybe you want this, I had to wait until age 60 before insurance would pay for it. 

Type of shingles vaccine cuts stroke risk by 16% in elderly

February 18, 2020

Quanhe Yang

A type of herpes zoster vaccine reduced risk for stroke in Medicare beneficiaries aged at least 66 years, according to findings presented at the International Stroke Conference.
Researchers analyzed 1,382,051 Medicare beneficiaries who received zoster vaccine live (Zostavax, Merck) between 2008 and 2014 and 1,382,051 controls matched based on numerous variables to determine whether receipt of the vaccine reduced stroke risk.

“The CDC’s Advisory Committee on Immunization Practices recommended the zoster vaccine live to prevent shingles for healthy adults older than 60 years in 2006. Zostavax was the only shingles vaccine that had sufficient data in Medicare datasets to study the relationship between Zostavax and risk for stroke,” Quanhe Yang, PhD, senior scientist with the epidemiology and surveillance branch in the CDC’s Division for Heart Disease and Stroke Prevention, told Healio.
During a mean follow-up of 3.9 years (5,890,113 person-years), there were 42,267 strokes in the vaccine group compared with 48,139 in controls. Crude incident rates for any stroke were 7.18 per 1,000 person-years in the vaccine group and 8.45 per 1,000 person-years in controls, translating to an approximately 16% reduction in the vaccine group (adjusted HR = 0.84; 95% CI, 0.83-0.85). For acute ischemic stroke, the rates were 5.4 per 1,000 person-years in the vaccine group and 6.53 per 1,000 person-years in controls (aHR = 0.82; 95% CI, 0.81-0.83), and for hemorrhagic stroke, the rates were 0.73 per 1,000 person-years in the vaccine group and 0.82 per 1,000 person-years in the control group (aHR = 0.88; 95% CI, 0.84-0.91).
“One in three people who had chickenpox will develop shingles in their lifetime, and there are 1 million shingles cases occurring in the United States each year,” Yang told Healio. “Two shingles vaccines are available to prevent shingles (Zostavax, a one-dose herpes zoster live-attenuated vaccine, and Shingrix [GlaxoSmithKline], a two-dose, adjuvant, recombinant vaccine). Our study also found the reduction in stroke risk associated with Zostavax vaccine, which may encourage people aged 50 or older to get vaccinated to prevent the shingles and shingles-associated risk for stroke. There are insufficient data in Medicare to study the relationship between Shingrix, which was recommended by the Advisory Committee on Immunization Practices in 2017, and risk for stroke.”
The association between use of the vaccine and reduced stroke risk was stronger in participants aged 66 to 79 years than in those aged 80 years or older (P for interaction = .02), but did not vary by race or sex, according to the researchers.
“Get vaccinated to reduce your risk for shingles, and it might also reduce your risk for stroke,” Yang said in an interview. – by Erik Swain
Reference:
Yang Q, et al. Poster Presentation TP493. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.

BRILINTA met primary endpoint in Phase III THALES trial in stroke

HOW LONG BEFORE THIS GETS TO A REHAB PROTOCOL IN YOUR HOSPITAL? I'm guessing decades, maybe in time for your children's and grandchildren's strokes. 

BRILINTA met primary endpoint in Phase III THALES trial in stroke

BRILINTA reduced the risk of the composite of stroke and
death after an acute ischemic stroke or transient ischemic attack

High-level results from the Phase III THALES trial showed AstraZeneca’s BRILINTA (ticagrelor) 90 mg used twice daily and taken with aspirin for 30 days, reached a statistically significant and clinically meaningful reduction in the risk of the primary composite endpoint of stroke and death, compared to aspirin alone.
THALES was conducted in over 11,000 patients who had a minor acute ischemic stroke or high-risk transient ischemic attack (TIA) in the 24 hours prior to treatment initiation. The preliminary safety findings in the THALES trial were consistent with the known profile of BRILINTA, with an increased bleeding rate in the treatment arm.
Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said: “Results of the Phase III THALES trial showed BRILINTA, in combination with aspirin, improved outcomes in patients who had experienced a minor acute ischemic stroke or high-risk transient ischemic attack. We look forward to sharing the detailed results with health authorities.”
Dr. Clay Johnston, lead investigator for the THALES trial and Dean of the Dell Medical School at The University of Texas at Austin, said: “The risk of having a subsequent stroke is highest in the first few days and weeks after a minor acute ischemic stroke or high-risk transient ischemic attack. While an expected increase in bleeding was observed, the findings from THALES showed that BRILINTA, in combination with aspirin, reduced the risk of potentially devastating events in this crucial time.”
The full THALES trial results will be presented at a forthcoming medical meeting.
BRILINTA is not indicated in patients with minor acute ischemic stroke or high-risk transient ischemic attack.
BRILINTA is indicated to reduce the rate of CV death, myocardial infarction (MI), and stroke in patients with ACS or a history of MI. For at least the first 12 months following ACS, it is superior to clopidogrel.
BRILINTA also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.
Dosing: In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Administer 90 mg twice daily during the first year after an ACS event. After one year administer 60 mg twice daily. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg.
IMPORTANT SAFETY INFORMATION FOR BRILINTA^® (ticagrelor) 60-MG AND 90-MG TABLETS
WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS
A.  BLEEDING RISK

• BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding
• Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
• Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery
• If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

B.  ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

• Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided

CONTRAINDICATIONS

• BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

WARNINGS AND PRECAUTIONS

• Dyspnea was reported in about 14% of patients treated with BRILINTA, more frequently than in patients treated with control agents. Dyspnea resulting from BRILINTA is often self-limiting
• Discontinuation of BRILINTA will increase the risk of MI, stroke, and death. When possible, interrupt therapy with BRILINTA for 5 days prior to surgery that has a major risk of bleeding. If BRILINTA must be temporarily discontinued, restart as soon as possible
• Ticagrelor can cause ventricular pauses. Bradyarrhythmias including AV block have been reported in the post-marketing setting. PLATO and PEGASUS excluded patients at increased risk of bradyarrhythmias not protected by a pacemaker, and they may be at increased risk of developing bradyarrhythmias with ticagrelor
• Avoid use of BRILINTA in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients
• In patients with Heparin Induced Thrombocytopenia (HIT): False negative results for HIT-related platelet functional tests, including the heparin-induced platelet aggregation (HIPA) assay, have been reported with BRILINTA. BRILINTA is not expected to impact PF4 antibody testing for HIT

ADVERSE REACTIONS

• The most common adverse reactions associated with the use of BRILINTA included bleeding and dyspnea: In PLATO, for BRILINTA vs clopidogrel, non-CABG    PLATO-defined major bleeding (3.9% vs 3.3%) and dyspnea (14% vs 8%); in PEGASUS, BRILINTA vs aspirin alone, TIMI Total Major bleeding (1.7% vs 0.8%) and dyspnea (14% vs 6%)

DRUG INTERACTIONS

• Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. BRILINTA is metabolized by CYP3A4/5. Strong inhibitors substantially increase ticagrelor exposure and so increase the risk of adverse events. Strong inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor
• As with other oral P2Y₁₂ inhibitors, co-administration of opioid agonists delay and reduce the absorption of ticagrelor. Consider use of a parenteral anti-platelet in ACS patients requiring co-administration
• Patients receiving more than 40 mg per day of simvastatin or lovastatin may be at increased risk of statin-related adverse events
• Monitor digoxin levels with initiation of, or change in, BRILINTA therapy

SPECIAL POPULATIONS

• Lactation: Breastfeeding not recommended

Please read full Prescribing Information, including Boxed WARNINGS, and Medication Guide.