Ticagrelor is an oral antiplatelet drug that is a reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12: it has a more rapid onset and produces more pronounced platelet inhibition than clopidogrel. Unlike clopidogrel and prasugrel which are prodrugs, ticagrelor does not need to be metabolised to become biologically active.
The efficacy of ticagrelor was studied in the PLATO study, a multi-centre, double-blinded and randomized trial,comparing ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300 – 600 mg loading dose, 75mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation. All patients also received aspirin at a dose of 75 – 100 mg daily unless not tolerated.
At 12 months, the findings of the PLATO study were that ticagrelor in combination with aspirin lowered the incidence of a composite outcome of death from vascular causes, MI or stroke more than the
combination of clopidogrel and aspirin. There were slightly more strokes among the group taking ticagrelor compared to those taking clopidogrel, but this was not a statistically significant difference.
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