Is ticagrelor worth its high cost and side-effects?

Abstract

Ticagrelor is a reversible P2Y₁₂ receptor antagonist that is more potent than clopidogrel. When used in combination with aspirin, it reduces cardiovascular events in patients with acute coronary syndrome. However, unbiased review of 5 randomised controlled trials indicates that although statistically significant, the clinical superiority of ticagrelor over clopidogrel is modest. Thus, identification of patients who benefit the most from ticagrelor is a priority. Besides bleeding issues, ticagrelor can frequently cause bouts of dyspnoea, which requires ticagrelor replacement by another P2Y₁₂ receptor antagonist, with a loading dose.

Keywords:

• Cardiovascular disease
• dyspnoea
• side effects
• ticagrelor

Disclosure statement

P.-V.E. reports echocardiography lectures/teaching sponsored by Daiichi Sankyo; Astra Zeneca; Philips and Bayer. S.M. has received consulting fees from BMS and Pfizer and reports echocardiography lectures/teaching financed by Bayer; Novartis; Daichi Sankyo; Philips Healthcare; GE Healthcare and Bracco Imaging. The remaining authors do not report conflict of interests.