Ticagrelor

(Brilinta®)

Ticagrelor

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Drug updated on 4/10/2024

Dosage FormTablet (oral; 60 mg, 90 mg)
Drug ClassP2Y12 platelet inhibitors
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated to reduce the risk of cardiovascular (CV) death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of MI.
  • Indicated to reduce the risk of a first MI or stroke in patients with coronary artery disease (CAD) at high risk for such events.
  • Indicated to reduce the risk of stroke in patients with acute ischemic stroke (NIH Stroke Scale score ≤5) or high-risk transient ischemic attack (TIA).

Summary
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  • Ticagrelor (Brilinta) is indicated to reduce the risk of cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome or a history of myocardial infarction. It's also used to decrease the risk of a first myocardial infarction or stroke in high-risk patients with coronary artery disease and to lower the chance of stroke in those with acute ischemic stroke or high-risk transient ischemic attack.
  • A review of 67 systematic reviews/meta-analyses was conducted on Ticagrelor compared against other antithrombotic agents such as clopidogrel, prasugrel, and rivaroxaban.
  • Compared to clopidogrel, ticagrelor demonstrated superiority in reducing major adverse cardiovascular events (MACEs) and stent thrombosis among acute coronary syndrome patients undergoing percutaneous coronary intervention. However, it was associated with higher bleeding risks, including intracranial hemorrhage.
  • The comparison between ticagrelor and prasugrel revealed mixed outcomes; some studies suggested that while prasugrel might have a lower incidence rate for strokes, it posed higher bleeding risks than ticagrelor. Therefore, specific factors should be evaluated when selecting between these two medications.
  • As part of dual antiplatelet therapy (DAPT), ticagrelor has shown benefits in reducing events such as strokes, myocardial infarctions, and cardiovascular deaths, especially over clopidogrel after percutaneous coronary intervention, but its increased bleeding risk remains a concern.
  • Subgroup considerations indicated that although ticagrelor reduced risks of major adverse cardiovascular events amongst elderly people and those with diabetes mellitus, there was a pronounced increase in their associated bleeding risks, particularly amongst older individuals.
  • Treatment outcomes varied across ethnic groups: Asians derived less benefit from Ticagrelor due to heightened bleeding risks, thus requiring careful consideration before its use within Asian populations.
  • The choice for antithrombotics, including Ticagrelor, should be personalized based on the patient's clinical profile, underlying risk factors for bleeding and ischemia, and specific patient subgroups (e.g., diabetes mellitus patients, elderly).
  • Ticagrelor offers a potent option for reducing thrombotic events in acute coronary syndrome patients and those undergoing percutaneous coronary intervention, but its associated increased bleeding risks must also be considered.
  • In populations such as Asians where the risk of bleeding may be higher, the benefits of ticagrelor should be carefully weighed against potential risks.

Product Monograph / Prescribing Information

Document TitleYearSource
Brilinta (ticagrelor) Prescribing Information.2022AstraZeneca Pharmaceuticals LP, Wilmington, DE

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Efficacy and safety outcomes of long-term anti-thrombotic treatment of chronic coronary artery disease: A systematic review and network meta-analysis.2023Frontiers in Cardiovascular Medicine
Prophylactic efficacy and safety of antithrombotic regimens in patients with stable atherosclerotic cardiovascular disease (S-ASCVD): A bayesian network meta-regression analysis.2023American Journal of Cardiovascular Drugs
Antithrombotic regimens for the prevention of major adverse cardiac events in chronic coronary syndrome: A systematic review and network meta-analysis.2023Frontiers in Cardiovascular Medicine
A comparison of antiplatelet therapy during the peri- and post-operative periods following flow-diverting stent insertion for unruptured intracranial aneurysms: A systematic review.2023Interventional Neuroradiology
Secondary prevention of antithrombotic therapy in patients with stable cardiovascular disease at high ischemic risk: A network meta-analysis of randomized controlled trials.2023Frontiers in Cardiovascular Medicine
Safety outcomes of anti-platelet therapy post coronary artery bypass graft surgery: A systematic review and network meta-analysis of randomized control trials.2023Perfusion
Safety and efficacy of ticagrelor versus clopidogrel in east asian patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with dual antiplatelet therapy: A meta-analysis of randomized controlled trials.2023Cardiology
Efficacy and Safety of Ticagrelor versus Aspirin and Clopidogrel for Stroke Prevention in Patients with Vascular Disease: A Systematic Review and Meta-Analysis.2023European Neurology
Abatement of potent P2Y12 antagonist-based dual antiplatelet therapy after coronary intervention: A network meta-analysis of randomized controlled trials.2023Frontiers in Cardiovascular Medicine
P2Y12 Inhibitors for Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis.2023The Texas Heart Institute Journal
Preferred monotherapy after short-term dual antiplatelet therapy: Systematic review and network meta-analysis of randomized trials.2023Journal of Cardiology
Efficacy and Safety of Ticagrelor versus Clopidogrel in Dialysis Patients with Coronary Syndromes: A Systematic Review and Meta-Analysis.2023Journal of Clinical Medicine
Short-Term DAPT and DAPT De-Escalation Strategies for Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis.2023Circulation: Cardiovascular Interventions
Comparison of Different Chronic Maintenance Antithrombotic Strategies in Patients with Coronary Artery Disease: A Systematic Review and Network Meta-Analysis.2023Cardiovascular Therapeutics
The effect of ticagrelor on coronary microvascular function after PCI in patients with ACS compared to clopidogrel: A systematic review and meta-analysis.2023PLoS One
Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.2023The American Journal of Cardiology
Efficacy and safety of de-escalation of antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome: A meta-analysis of randomized clinical trials.2022Journal of Cardiovascular Pharmacology
Efficacy and safety of clopidogrel versus ticagrelor as part of dual antiplatelet therapy in acute coronary syndrome - a systematic review and meta-analysis.2022Journal of Cardiovascular Pharmacology
Comparison of clinical outcomes between ticagrelor and clopidogrel in acute coronary syndrome: A comprehensive meta-analysis.2022Frontiers in Cardiovascular Medicine
Comparison of prasugrel and ticagrelor for patients with acute coronary syndrome: A systematic review and meta-analysis.2022Cardiology
Effect of CYP2C19 genetic polymorphism on the pharmacodynamics and clinical outcomes for patients treated with ticagrelor: A systematic review with qualitative and quantitative meta-analysis. 2022BMC Cardiovascular disorders
Comparison of ticagrelor with clopidogrel in East Asian patients with acute coronary syndrome: A systematic review and meta-analysis of randomized clinical trials.2022Journal of Cardiovascular Pharmacology
P2Y12 inhibitors plus aspirin for acute treatment and secondary prevention in minor stroke and high-risk transient ischemic attack: A systematic review and meta-analysis.2022European Journal of Internal Medicine
Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: A meta-analysis.2022Frigid Zone Medicine
Acute coronary syndrome and renal impairment: A systematic review. 2022Reviews in Cardiovascular Medicine
Dual Antiplatelet Therapy in Patients Aged 75 Years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review.2022Journal of Interventional Cardiology
P2Y12 receptor inhibitor plus aspirin versus aspirin treated within 24 hours of acute noncardioembolic ischemic stroke or TIA: Meta-analysis.2022Journal of the Formosan Medical Association
Early vs. delayed initiation of treatment with P2Y12 inhibitors in patients with non-ST-segment elevation acute coronary syndrome: A systematic review and network meta-analysis of randomized controlled trials.2022Frontiers in Cardiovascular Medicine
Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials.2022Frontiers in Pharmacology
Effect of ticagrelor monotherapy on mortality after percutaneous coronary intervention: A systematic review and meta-analysis of randomized trials including 26 143 patients.2022European Heart Journal - Cardiovascular Pharmacotherapy
Newer P2Y12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis.2022Mayo Clinic Proceedings
Antithrombotic Therapy for Symptomatic Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis.2022Drugs
Comparison of Unguided De-Escalation Versus Guided Selection of Dual Antiplatelet Therapy After Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis .2022Circulation: Cardiovascular Interventions
Impact of prasugrel and ticagrelor on platelet reactivity in patients with acute coronary syndrome: A meta-analysis.2022Frontiers in Cardiovascular Medicine
Efficacy of ticagrelor compared to clopidogrel in improving endothelial function in patients with coronary artery disease: A systematic review.2022Journal of Cardiovascular Medicine
Antithrombotic therapy for secondary prevention in patients with stroke or transient ischemic attack: A multiple treatment network meta-analysis of randomized controlled trials.2022PLoS One
Efficacy and Safety of Antiplatelet Therapies in Symptomatic Peripheral Artery Disease: A Systematic Review and Network Meta-Analysis.2021Current Vascular Pharmacology
Optimal duration and combination of antiplatelet therapies following percutaneous coronary intervention: A meta-analysis.2021Vascular Pharmacology
Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: A systematic review and meta-analysis of randomized clinical trials. 2021European Heart Journal
Effect of CYP2C19 genotype on ischemic outcomes during oral P2Y12 inhibitor therapy: A meta-analysis.2021JACC: Cardiovascular Interventions
De-escalation of dual antiplatelet therapy in patients with acute coronary syndromes.2021Journal of the American College of Cardiology
Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis.2021The Lancet
Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: A systematic review and network meta-analysis.2021BMC Neurology
Efficacy and safety of using dual versus monotherapy antiplatelet agents in secondary stroke prevention: Systematic review and meta-analysis of randomized controlled clinical trials.2021Circulation
Antiplatelet regimens for Asian patients with ischemic stroke or transient ischemic attack: A systematic review and network meta-analysis.2021Annals of Translational Medicine
Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: A systematic review and meta-analysis.2021F1000Research
Efficacy and safety of ticagrelor monotherapy in patients following percutaneous coronary intervention.2021Medicine
Ticagrelor as compared to conventional antiplatelet agents in coronary artery disease: A comprehensive meta-analysis of 15 randomized trials.2021Vascular Pharmacology
Effects of clopidogrel, prasugrel and ticagrelor on prevention of stent thrombosis in patients underwent percutaneous coronary intervention: A network meta-analysis.2021Clinical Cardiology
Potent P2Y12 inhibitors versus Clopidogrel in elderly patients with acute coronary syndrome: Systematic review and meta-analysis.2021American Heart Journal
Efficacy and Safety of Ticagrelor in Diabetes Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.2021Journal of Cardiovascular Pharmacology
Coronary Heart Disease (CHD) in Elderly Patients: Which Drug to Choose, Ticagrelor and Clopidogrel? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.2021Journal of Cardiovascular Development and Disease
Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.2021Frontiers in Pharmacology
Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: A systematic review and meta-analysis.2020Postgraduate Medical Journal
Prasugrel vs ticagrelor for DAPT in patients with ACS undergoing PCI: A systematic review and meta-analysis of randomized controlled trials.2020Cardiovascular Revascularization Medicine
Ticagrelor for the primary prevention of stroke in patients with coronary artery disease: A systematic review and meta-analysis of randomized controlled trials.2020Journal of Thrombosis and Thrombolysis
Risk of bradyarrhythmia related to ticagrelor: A systematic review and meta-analysis.2020Pharmacological Research
Comparison of platelet reactivity between prasugrel and ticagrelor in patients with acute coronary syndrome: A meta-analysis.2020BMC Cardiovascular Disorders
Prasugrel versus ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomized trials.2020Cardiovascular Drugs and Therapy
The risk of dyspnea in patients treated with third-generation P2Y12 inhibitors compared with clopidogrel: A meta-analysis of randomized controlled trials.2020BMC Cardiovascular Disorders
P2Y 12 inhibitors with oral anticoagulation for percutaneous coronary intervention with atrial fibrillation: A systematic review and meta-analysis.2020Heart
Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: A network meta‑analysis.2020Scientific Reports
Ticagrelor for Asian patients with acute coronary syndrome in real-world practice: A systematic review and meta-analysis of observational studies.2019Indian Heart Journal
Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients.2019Current Vascular Pharmacology
Efficacy and safety of ticagrelor compared to clopidogrel in patients undergoing percutaneous coronary intervention: A meta-analysis.2019Current Pharmaceutical Design
Comparisons between ticagrelor and clopidogrel following percutaneous coronary intervention in patients with acute coronary syndrome: A comprehensive meta-analysis.2019Drug Design, Development and Therapy
Prasugrel vs. ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: a systematic review and meta‑analysis.2019American Journal of Cardiovascular Drugs
Effect of Pre-Hospital Ticagrelor in Primary Percutaneous Coronary Intervention on Patients with ST-Segment Elevation Myocardial Infarction: A systematic review and meta-analysis.2019The Journal of Pakistan Medical Association

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