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.

Lay abstract

Heart attacks occur when blood cells form clots within heart blood vessels. Blood clots in heart blood vessels are potentially dangerous as they can reduce the flow of blood to heart muscle. Patients who are at risk of heart attacks are more likely to form these blood clots in heart blood vessels and need to take tablets to prevent this from happening. Ticagrelor is a tablet which is taken twice a day to reduce the formation of these blood clots and thereby reduces the chance of having a heart attack. A number of research studies including patients from all over the world have shown that patients who take ticagrelor are at a lower risk of a heart attack when it is used in combination with aspirin. Ticagrelor is commonly used together with aspirin in patients who have had treatment to their heart arteries after using coronary stents or following a heart attack. Patients are advised to take ticagrelor for 1 year following treatment to their heart arteries, however recently research studies have questioned whether patients with higher risks of heart attacks should be treated for longer periods. If patients take ticagrelor for longer than 1 year, the benefits of reducing heart attacks are countered by higher rates of bleeding which may require hospital admission. Current research studies are focusing on using more precise markers to help doctors decide whether certain patient groups will benefit from taking ticagrelor instead of aspirin or alternative blood thinning tablets. These results are discussed in this review article.

Keywords:

• antiplatelet therapy
• coronary artery disease
• Ticagrelor

Financial & competing interests disclosure

PD Adamson is supported by a Heart Foundation of New Zealand Senior Fellowship (1844). AJ Moss is supported by a British Heart Foundation Accelerator Award Clinical Lectureship (Grant AA/18/3/34220). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.