title: Review of  ticagrelor  in the management of acute coronary syndromes.
abstract: BACKGROUND
  Ticagrelor, an oral P2Y(12) receptor antagonist used as part of dual antiplatelet therapy in the treatment of acute coronary syndromes (ACS), has many favorable characteristics when compared with the more frequently used P2Y(12) receptor antagonist clopidogrel. Ticagrelor binds reversibly, with a rapid onset and offset of action, and produces high levels of platelet inhibition without variation secondary to genetic polymorphism. Ticagrelor produces increased platelet inhibition and an overall reduction in adverse cardiac events compared with clopidogrel. Clinically relevant side effects include an increase in non-CABG-related bleeding events as well as off-target adverse effects including ventricular pauses and dyspnea.
  
  
  METHODS
  This article details ticagrelor's pharmacokinetic and pharmacodynamic characteristics, development and chemical properties. The authors review relevant clinical trials looking at the efficiency and safety of ticagrelor focusing predominantly on the management of patients with ACS. Finally, the review article concludes with discussion of ticagrelor's current role and future integration into clinical practice.
  
  
  CONCLUSIONS
  Ticagrelor is a promising P2Y(12) receptor antagonist with characteristics that offer advantages for patients beyond those currently demonstrated by other P2Y(12) receptor antagonists. The challenge for prescribers is to identify those most likely to benefit from ticagrelor treatment while minimizing unnecessary bleeding events for 'real-world' ACS patients.
authors.affiliation: Department of Cardiology, Liverpool Hospital, Liverpool NSW, Australia.
authors.forename: Sonya
authors.initials: S
authors.lastname: Burgess
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Mallard
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000241:Adenosine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000077144:Clopidogrel; D004417:Dyspnea / Q000188:drug therapy; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics; D017410:Practice Guidelines as Topic; D058921:Purinergic P2Y Receptor Antagonists / Q000493:pharmacokinetics*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine