title: Current controversies in the use of aspirin and ticagrelor for the treatment of thrombotic events.
abstract: A P2Y12inhibitor 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 P2Y12receptor 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 P2Y12receptor blockade via ticagrelor monotherapy or replacing aspirin with an oral anticoagulant.
authors.affiliation: a Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust and Faculty of Medicine , Brighton and Sussex Medical School , Brighton , UK.
authors.forename: Aung
authors.initials: A
authors.lastname: Myat
authors.affiliation: b Inova Center for Thrombosis Research and Drug Development , Inova Heart and Vascular Institute , Falls Church , VA , USA.
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
authors.affiliation: c Department of Cardiology, and Internal Medicine, Ludwik Rydygier Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.affiliation: b Inova Center for Thrombosis Research and Drug Development , Inova Heart and Vascular Institute , Falls Church , VA , USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: Aspirin; acute coronary syndrome; coronary artery disease; major bleeding; myocardial infarction; ticagrelor