title: Advances in antiplatelet technologies to improve cardiovascular disease morbidity and mortality: a review of ticagrelor.
abstract: Antiplatelet therapy is widely used with proven benefit for the prevention of further ischemic cardiac complications in patients with acute coronary syndrome. Treatment guidelines for acute coronary syndrome and percutaneous coronary intervention now recommend the use of oral antiplatelet agents including ticagrelor, prasugrel, or clopidogrel in combination with aspirin to comprise dual antiplatelet therapy for the prevention of recurrent ischemic events. The limitations of conventional antiplatelet therapy with clopidogrel or prasugrel include the potential for low response to clopidogrel identified through platelet reactivity or genetic testing, increased risk of bleeding with prasugrel, or slower return to normal platelet activity in patients who received either prasugrel or clopidogrel prior to emergent or planned surgical procedures. This review will discuss the pharmacokinetic and pharmacodynamic properties of ticagrelor in comparison to conventional P2Y12 receptor inhibitors and its utility in patients identified as low responders to clopidogrel. Completed clinical studies and substudies comparing ticagrelor to clopidogrel and ongoing clinical trials evaluating ticagrelor in acute coronary syndrome patients will also be reviewed.
authors: Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
authors: Estella M
authors: EM
authors: Davis
authors: Jon T
authors: JT
authors: Knezevich
authors: Robyn M
authors: RM
authors: Teply
keywords: ST elevation myocardial infarction; acute coronary syndrome; antiplatelet; non-ST elevation MI; percutaneous coronary intervention; ticagrelor
references: Lancet. 2010 Oct 9;376(9748):1233-43
references: 20817281
references: Ther Clin Risk Manag. 2011;7:473-88
references: 22241944
references: Eur Heart J. 2012 Oct;33(20):2569-619
references: 22922416
references: Eur Heart J. 2013 Jan;34(3):220-8
references: 22719022
references: J Am Coll Cardiol. 2012 Oct 23;60(17):1623-30
references: 23021325
references: Circulation. 2012 Jun 12;125(23):2914-21
references: 22572911
references: Clin Cardiol. 2012 Nov;35(11):647-8
references: 23023302
references: J Am Coll Cardiol. 2012 Jul 17;60(3):193-9
references: 22789884
references: Circulation. 2010 Aug 3;122(5):537-57
references: 20585015
references: J Am Coll Cardiol. 2011 Feb 8;57(6):672-84
references: 21194870
references: Drug Metab Dispos. 2011 Apr;39(4):703-10
references: 21177984
references: Curr Opin Cardiol. 2010 Jul;25(4):321-8
references: 20386440
references: J Clin Pharm Ther. 2012 Aug;37(4):464-8
references: 21967645
references: J Clin Pharmacol. 2012 Sep;52(9):1388-98
references: 21960668
references: Circulation. 2012 Aug 14;126(7):875-910
references: 22800849
references: Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):680-8
references: 22991347
references: Fundam Clin Pharmacol. 2011 Oct;25(5):564-71
references: 21077944
references: Drug Metab Dispos. 2010 Sep;38(9):1514-21
references: 20551239
references: Eur J Clin Pharmacol. 2010 May;66(5):487-96
references: 20091161
references: Circulation. 2010 Mar 16;121(10):1188-99
references: 20194878
references: QJM. 2011 Jul;104(7):561-9
references: 21572108
references: Circulation. 2011 Aug 2;124(5):544-54
references: 21709065
references: Br J Clin Pharmacol. 2010 Jul;70(1):65-77
references: 20642549
references: N Engl J Med. 2009 Sep 10;361(11):1045-57
references: 19717846
references: Eur J Clin Pharmacol. 2012 Aug;68(8):1175-82
references: 22367426
references: Int J Cardiol. 2011 Aug 4;150(3):325-31
references: 20828843
references: J Am Coll Cardiol. 2007 Nov 6;50(19):1852-6
references: 17980251
references: Eur Heart J. 2011 Dec;32(23):2945-53
references: 21804104
references: J Am Coll Cardiol. 2010 Sep 14;56(12):919-33
references: 20828644
references: Circulation. 2010 Nov 23;122(21):2131-41
references: 21060072
references: N Engl J Med. 2009 Jan 22;360(4):354-62
references: 19106084
references: N Engl J Med. 2012 Nov 29;367(22):2100-9
references: 23121439
references: J Am Coll Cardiol. 2013 Jan 29;61(4):e78-e140
references: 23256914
references: Eur Heart J. 2010 Dec;31(24):3006-16
references: 20802246
references: Eur Heart J. 2009 Jul;30(14):1744-52
references: 19429918
references: J Am Coll Cardiol. 2007 Nov 6;50(19):1844-51
references: 17980250
references: Circulation. 2009 May 19;119(19):2553-60
references: 19414633
references: Circulation. 2011 Dec 6;124(23):e574-651
references: 22064601
references: Vasc Health Risk Manag. 2010 Jun 01;6:419-29
references: 20539844
references: Am J Cardiol. 2011 Dec 1;108(11):1542-6
references: 21890085
references: Am Heart J. 2011 Jan;161(1):1-4
references: 21167333
references: J Am Coll Cardiol. 2012 Jun 12;59(24):2159-64
references: 22520250
references: Eur Heart J. 2011 Dec;32(23):2999-3054
references: 21873419
references: Thromb Haemost. 2012 Aug;108(2):318-27
references: 22627948
references: BMJ. 2011 Jun 17;342:d3527
references: 21685437
references: J Am Coll Cardiol. 2011 May 10;57(19):1908-16
references: 21545948
references: Circulation. 2009 Dec 22;120(25):2577-85
references: 19923168
references: Lancet. 2010 Jan 23;375(9711):283-93
references: 20079528
references: Circulation. 2010 Sep 14;122(11):1056-67
references: 20805430
references: J Am Coll Cardiol. 2011 Feb 8;57(6):685-7
references: 21194871
references: Eur Heart J. 2006 May;27(9):1038-47
references: 16476694
references: J Clin Pharmacol. 2011 Jul;51(7):978-87
references: 20926753
references: Circ Cardiovasc Interv. 2012 Dec;5(6):797-804
references: 23169985
references: Value Health. 2011 Jun;14(4):483-91
references: 21669373
references: J Am Coll Cardiol. 2010 Oct 26;56(18):1456-62
references: 20832963
references: Br J Pharmacol. 2010 Feb 1;159(3):502-17
references: 20050853
references: JAMA. 2011 Mar 16;305(11):1097-105
references: 21406646
references: Eur Heart J. 2010 Oct;31(20):2501-55
references: 20802248
references: Am J Ther. 2013 Jul-Aug;20(4):337-43
references: 21519219
references: J Am Coll Cardiol. 2010 Jul 13;56(3):185-93
references: 20620737