Current controversies in the use of aspirin and ticagrelor for the treatment of thrombotic events

ABSTRACT

Introduction: A P2Y₁₂ inhibitor plus aspirin is the most widely used antiplatelet strategy to prevent adverse outcomes in the setting of atherothrombotic vascular disease.

Areas covered: A paucity of robust evidence for an optimal dose, gastrointestinal toxicity, ineffectiveness in high-risk patients and interactions with other antiplatelet agents, are major controversies associated with aspirin therapy. Ticagrelor is a reversibly binding oral P2Y₁₂ receptor blocker that mediates potent inhibition of adenosine diphosphate-induced platelet function. It is more effective than clopidogrel in preventing thrombotic events in acute coronary syndrome patients. The absence of a beneficial effect for ticagrelor versus clopidogrel in ACS observed in the North American subgroup of the PLATelet inhibition and patient Outcomes (PLATO) trial has been attributed to a higher concomitant aspirin dose.

Expert commentary: Ongoing studies are now investigating the plausibility of removing aspirin therapy in the setting of potent P2Y₁₂ receptor blockade via ticagrelor monotherapy or replacing aspirin with an oral anticoagulant.

KEYWORDS:

• Aspirin
• ticagrelor
• coronary artery disease
• myocardial infarction
• acute coronary syndrome
• major bleeding

Declaration of interest

PA Gurbel reports personal fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo/LilIy, Merck, Janssen Pharmaceuticals, New Haven Pharmaceuticals, Bayer, and Haemonetics; grants from Haemonetics, Merck, Duke Clinical Research Institute, Harvard Clinical Research Institute, National Institutes of Health, New Haven Pharmaceuticals, Coramed Technologies, Medlmmune, and Sinnowa; a patent for platelet function testing; and stock options in Merck. 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.

Additional information

Funding

This paper was not funded.