Ticagrelor: An emerging oral antiplatelet agent

ABSTRACT

Acute coronary syndrome (ACS) is a leading cause of myocardial infarction in the world. It is one of the major cause of mortality in the present lifestyle scenario and a main reason for hospital admissions. A critical role in atherothrombosis is played by platelets. Antiplatelet agents are of great therapeutic value in thromboembolic diseases. Potent inhibitors of platelet function have been developed in recent years, resulting in lowered rates of restenosis and thrombosis after angioplasty and vascular stenting procedures. Aspirin has been the gold standard antiplatelet agent for the prophylaxis of myocardial infarction and other thromboembolic events. The thienopyridenes (clopidogrel, ticlopidine and prasugrel) are another class of antiplatelet agents that inhibit adenosine diphosphate induced platelet aggregation irreversibly via P2Y12 receptor located on the surface of platelets. It has been seen that 1 in 3 ACS patient dies due to repeat MI despite intensive monitoring and prompt treatment of cardiac instability, thrombolytic activity, acute invasive interventions and dual antiplatelet therapy with aspirin and thienopyridines. In patients with ACS, the most commonly used thienopyridine is clopidogrel. However, it has some limitations. It causes irreversible inhibition of platelets and thus may increase the risk of bleeding in patients who may require surgery/intervention. Moreover, it requires hepatic conversion to an active metabolite resulting in delayed onset of action and there is an interindividual variation in conversion rate due to pharmacogenomic differences. The mean levels of inhibition of ADP-induced platelet aggregation with clopidogrel are modest. So, there is a need to have a new antiplatelet agent without all these drawbacks. Ticagrelor is expected to confer better antiplatelet effects to patients with ACS while being devoid of these demerits.

KEYWORDS

• Molecules of the Millennium

Showing references and in-text citations exactly as published.

Cite this article

• DOI10.4103/0976-500X.107698Copy

RELATED ARTICLES

Matched on section and article type within this issue of J Pharmacol. Pharmacother..

• Article · VOLUME 4, ISSUE 1Continuing β-blockers after noncardiac surgery improves patient outcomes and lowers mortalityG G · pp. 74–75Same type: Article
• Article · VOLUME 4, ISSUE 1Effect of Casilan® on 13C-caffeine metabolism in overnight-fasted healthy Nigerian childrenKazeem A. Oshikoya, Ken Smith · pp. 19–26Same type: Article
• Article · VOLUME 4, ISSUE 1Effect of addition of either sitagliptin or pioglitazone in patients with uncontrolled type 2 diabetes mellitus on metformin: A randomized controlled trialShalini Chawla, Nitin Kaushik, Narinder Pal Singh, Raktim Kumar Ghosh, Alpana Saxena · pp. 27–32Same type: Article
• Article · VOLUME 4, ISSUE 1Comparison of the efficacy and tolerability of ivabradine and ranolazine in patients of chronic stable angina pectorisAditi Chaturvedi, Yogendra Singh, Harish Chaturvedi, Vijay Thawani, Sakshi Singla, Deepak Parihar · pp. 33–33Same type: Article