From the Guidelines
Brilinta (ticagrelor) is preferred over Plavix (clopidogrel) for patients with acute coronary syndromes due to its more potent and rapid inhibition of platelet activation, despite a higher risk of bleeding, as stated in the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes 1. The main differences between Brilinta and Plavix are:
- Onset of action: Brilinta works more quickly than Plavix, as it does not require metabolic activation in the liver to form its active metabolite, whereas Plavix requires biotransformation in the liver to reach its maximal platelet inhibition after a loading dose 1.
- Potency: Brilinta is more potent than Plavix, achieving more rapid onset of inhibition of platelet activation, but with an increased risk of bleeding compared to Plavix 1.
- Dosing: Brilinta is typically taken twice daily, while Plavix is taken once daily.
- Side effects: Brilinta may cause subjective transient dyspnea in approximately 10% to 15% of patients after ACS, a side effect not typically seen with Plavix 1.
- Interactions: Brilinta should not be used with aspirin doses exceeding 100mg daily, while Plavix has fewer interaction concerns. The choice between these medications depends on the specific condition being treated, patient characteristics, bleeding risk, cost considerations, and medication adherence ability, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Difference between Brillinta and Plavix
- Brillinta (ticagrelor) and Plavix (clopidogrel) are both antiplatelet drugs used to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) 2.
- The main difference between the two drugs is their mechanism of action and potency, with ticagrelor being a more potent P2Y12 inhibitor compared to clopidogrel 3, 4, 5.
Efficacy and Safety
- Studies have shown that ticagrelor is associated with a lower risk of major adverse cardiovascular events (MACE) compared to clopidogrel in patients with ACS undergoing percutaneous coronary intervention (PCI) 3, 5.
- However, ticagrelor has also been shown to have a higher risk of bleeding events, such as hemorrhagic stroke or gastrointestinal bleeding, compared to clopidogrel 4.
- A study found that ticagrelor was associated with a significantly lower risk of ischemic events, but not bleeding events, compared to clopidogrel in patients with ACS undergoing complex PCI 5.
Specific Patient Populations
- In Asian patients with ACS, a loading dose of ticagrelor was found to be more effective in preventing periprocedural myocardial infarction compared to clopidogrel 6.
- Another study found that ticagrelor was associated with a lower risk of MACE and hospitalization compared to clopidogrel in a real-world high-risk cohort of patients with ACS 3.
Comparison of Outcomes
- A study comparing the outcomes of ticagrelor and clopidogrel in patients with ACS found that ticagrelor was not associated with a significant difference in the risk of net adverse clinical events (NACE) at 12 months, but was associated with a higher risk of hemorrhagic events and dyspnea 4.
- Overall, the choice between ticagrelor and clopidogrel should be based on individual patient characteristics and risk factors, as well as the specific clinical context 2, 3, 4, 5, 6.