title: Safety profile and bleeding risk of ticagrelor compared with clopidogrel.
abstract: BACKGROUND
  Ticagrelor is a novel, non-thienopyridine ADP inhibitor that reversibly blocks the P2Y(12) receptor, preventing platelet activation and aggregation. It is the first ADP inhibitor to show a mortality benefit in patients with acute coronary syndromes (ACS). Its major safety concern, as with the other ADP blockers, is bleeding. Other common adverse effects of ticagrelor such as dyspnea and ventricular pauses appear to be mild and self-limited.
  
  
  METHODS
  The pharmacological properties of ticagrelor compared with clopidogrel are explored in this article. In addition, the relevant clinical trials in which ticagrelor was investigated are described, with an emphasis on efficacy and safety end points.
  
  
  CONCLUSIONS
  Although some patients suffer from dyspnea when administered with ticagrelor, there is no evidence of any untoward effects on the cardiovascular or pulmonary systems. Given that the majority of these episodes are mild to moderate and self-limiting, patients should be encouraged to continue the medication, as symptoms may resolve. Furthermore, patients with underlying heart failure or lung disease do not appear to be at an increased risk of developing ticagrelor-induced dyspnea. Its overall mortality benefit among patients with ACS, along with its ability to inhibit platelet aggregation more rapidly and consistently, makes it the preferred agent over clopidogrel.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue/J2-3, Cleveland, OH 44195, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: May
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D000077144:Clopidogrel; D004417:Dyspnea / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology; D012307:Risk Factors; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine