Ticagrelor in the Management of Coronary Artery Disease

Abstract

Ticagrelor is a potent and orally active P2Y12 inhibitor. Ticagrelor has been extensively tested in Phase II and Phase III trials in patients with coronary artery disease. The pharmacokinetics and pharmacodynamics of Ticagrelor result in more rapid and effective inhibition of platelet activation compared with other P2Y12 inhibitors. This has resulted in a reduction in recurrent major cardiovascular events in initial randomized controls trials comparing Ticagrelor with clopidogrel. More recently, clinical trials have investigated the use of Ticagrelor in patients with stable coronary artery disease and a high residual risk of coronary thrombotic events. In patients with stable coronary artery disease, the potent antiplatelet effect of Ticagrelor is counterbalanced by an increased risk of major bleeding. Further research is ongoing to determine the optimal duration of Ticagrelor therapy.

Low platelet reactivity in patients with myocardial infarction treated with aspirin plus ticagrelor

“…High levels of platelet aggregation inhibition may be explained by the direct effect and potent reduction of thromboxane A2 and other platelet agonists by ticagrelor combined with the irreversible antiplatelet effect of acetylsalicylic acid (ASA). (21) Results presented beg the question of whether less intensive platelet inhibition strategies based on modern P2Y 12 receptor antagonists might attenuate LPR and possibly reduce the risk of bleeding without increasing thrombotic events in this clinical setting. For instance, findings of this study may inform future clinical trials testing monotherapy with ticagrelor (i.e., without aspirin) in patients submitted to coronary interventions.…”