From the Guidelines
The brand name of ticagrelor is Brilinta, while prasugrel is marketed as Effient. Both medications are oral antiplatelet agents belonging to the class of P2Y12 receptor antagonists, which are commonly prescribed to prevent blood clots in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention (PCI) 1.
Key Points
- Ticagrelor (Brilinta) is typically dosed at 90 mg twice daily after a 180 mg loading dose, while prasugrel (Effient) is usually given as 10 mg once daily following a 60 mg loading dose.
- These medications work by preventing platelets from sticking together, thereby reducing the risk of dangerous blood clots that can cause heart attacks and strokes.
- It's essential to note that these medications are often prescribed alongside aspirin as dual antiplatelet therapy, and patients should be aware that they increase bleeding risk.
- Patients should take these medications exactly as prescribed and not discontinue them without consulting their healthcare provider, as premature discontinuation can lead to serious cardiovascular events.
Mechanism and Side Effects
- Ticagrelor has a more rapid and consistent onset of action compared to clopidogrel, and because it is reversible, it has a faster recovery of platelet function 1.
- Side effects unique to ticagrelor include dyspnea (which occurs in up to 15% of patients within the first week of treatment but is rarely severe enough to cause discontinuation of treatment) and bradycardia.
- The benefit of ticagrelor over clopidogrel was limited to patients taking 75 mg to 100 mg of aspirin.
Clinical Considerations
- When possible, ticagrelor should be discontinued at least 5 days before surgery.
- Although ticagrelor has not been studied in the absence of aspirin, its use in aspirin-intolerant patients is a reasonable alternative.
- The short half-life of ticagrelor requires twice-daily administration, which could potentially result in adverse events in non-compliant patients, particularly after stent implantation.
From the Research
Brand Names of Ticagrelor and Prasugrel
- The brand names of ticagrelor are Brilique and Brilinta 2, 3, 4.
- The brand name of prasugrel is Effient 4, 5, 6.
Key Points
- Ticagrelor is an orally active, reversible, and selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with acute coronary syndromes (ACS) 2, 3.
- Prasugrel is a P2Y12 inhibitor that provides greater inhibition of platelet aggregation and has a rapid onset of action 5, 6.
- Both ticagrelor and prasugrel are used in combination with aspirin to reduce the rate of thrombotic cardiovascular events in patients with ACS 4, 5, 6.