From the Guidelines
No, ticagrelor is not an anticoagulant. Ticagrelor (brand name Brilinta) is classified as an antiplatelet medication, specifically a P2Y12 receptor antagonist. While both antiplatelet drugs and anticoagulants work to prevent blood clots, they do so through different mechanisms. Ticagrelor works by preventing platelets from sticking together by blocking the P2Y12 receptor on platelets, which inhibits platelet aggregation. This differs from anticoagulants like warfarin, heparin, or direct oral anticoagulants (DOACs) which target the coagulation cascade and clotting factors.
Key Points
- Ticagrelor is typically prescribed at doses of 60-90 mg twice daily for patients with acute coronary syndromes or history of myocardial infarction 1.
- It's essential to understand the distinction between antiplatelet medications and anticoagulants because they have different indications, side effect profiles, and bleeding risks.
- Patients taking ticagrelor should be aware that it increases bleeding risk and should inform healthcare providers before any surgical procedures.
- In certain scenarios, such as acute coronary syndrome (ACS), ticagrelor may be used in combination with anticoagulants, but the risk of bleeding needs to be carefully weighed against the potential benefits 1.
Clinical Considerations
- The initial antiplatelet of choice in patients receiving anticoagulation during ACS is clopidogrel due to the higher risk of bleeding associated with ticagrelor versus clopidogrel 1.
- However, in patients who are at exceptionally high risk for stent thrombosis, the risks of bleeding may not outweigh the benefits of ticagrelor use, and ticagrelor may be a better P2Y12 inhibitor to use in these circumstances.
- Triple therapy, or aspirin + a P2Y12 inhibitor + an OAC, should only be reserved for patients at the highest risk for thrombotic complications, and ideally not exceed 30 days 1.
From the Research
Definition of Anticoagulant and Antiplatelet Medication
- An anticoagulant is a medication that prevents the formation of blood clots, whereas an antiplatelet medication prevents the aggregation of platelets to form a blood clot.
- Ticagrelor is classified as an antiplatelet medication, specifically a P2Y12 receptor inhibitor.
Mechanism of Action of Ticagrelor
- Ticagrelor works by reversibly binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from inducing platelet activation and aggregation 2.
- This mechanism of action is different from anticoagulants, which typically work by inhibiting the coagulation cascade.
Comparison with Anticoagulants
- Anticoagulants, such as bivalirudin, unfractionated heparin, enoxaparin, and fondaparinux, are used to prevent the formation of blood clots in conditions such as atrial fibrillation and deep vein thrombosis 3.
- Ticagrelor, on the other hand, is used to prevent platelet aggregation in conditions such as acute coronary syndrome.
Clinical Use of Ticagrelor
- Ticagrelor is used in combination with aspirin for the treatment of acute coronary syndrome, and has been shown to be more effective than clopidogrel in reducing cardiovascular events 4, 2, 5.
- The use of ticagrelor is not without risks, and common adverse effects include bleeding, dyspnea, and elevation of serum creatinine and uric acid 4, 2, 5.