From the Guidelines
Yes, ticagrelor (Brilinta) and acetylsalicylic acid (Aspirin) can be taken together, particularly for patients with acute coronary syndrome or after coronary stent placement, as recommended by the most recent guidelines. The typical regimen includes Brilinta 90 mg twice daily along with low-dose aspirin (usually 81 mg once daily) 1. This combination works more effectively than either medication alone because they prevent blood clots through different mechanisms. Brilinta blocks ADP receptors on platelets, while aspirin inhibits thromboxane production.
Key Considerations
- The combination of ticagrelor and aspirin increases bleeding risk, so patients should promptly report any unusual bleeding or bruising to their healthcare provider 1.
- It's essential to take both medications exactly as prescribed and not stop either one without consulting your doctor, as premature discontinuation can increase the risk of heart attack, stroke, or death, especially in patients with stents 1.
- Some patients may experience side effects like shortness of breath with Brilinta or stomach irritation with aspirin, which should be discussed with a healthcare provider 1.
Guideline Recommendations
- The 2024 ESC guidelines recommend dual antiplatelet therapy with a P2Y12 inhibitor (such as ticagrelor) on top of aspirin for patients with acute coronary syndrome or after coronary stent placement, unless there are contraindications such as an excessive risk of bleeding 1.
- The 2019 ESC/EACTS guidelines recommend a P2Y12 inhibitor (such as ticagrelor) in addition to aspirin, maintained over 12 months unless there are contraindications 1.
- The 2018 ESC focused update on dual antiplatelet therapy in coronary artery disease recommends ticagrelor (180 mg loading dose, 90 mg twice daily) on top of aspirin for patients with acute coronary syndrome, regardless of initial treatment strategy 1.
From the Research
Combination of Ticagrelor and Acetylsalicylic Acid
- The combination of ticagrelor and acetylsalicylic acid (aspirin) is a recommended treatment for patients with acute coronary syndrome (ACS) 2, 3, 4.
- Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, such as ticagrelor, reduces cardiovascular event rates after ACS 3.
- The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend aspirin plus a P2Y12 inhibitor for at least 12 months for patients with ACS 3.
Efficacy and Safety
- Clinical trials have shown that ticagrelor plus aspirin reduces overall mortality and cardiovascular mortality compared to clopidogrel plus aspirin in patients with ACS 5.
- However, ticagrelor plus aspirin also increases the risk of bleeding compared to clopidogrel plus aspirin 5.
- A recent study found that ticagrelor alone, compared to ticagrelor plus aspirin, reduces the incidence of clinically relevant bleeding events without an accompanying increase in major adverse cardiovascular or cerebrovascular events (MACCE) 6.
Patient Characteristics and Treatment Duration
- The choice of antiplatelet therapy and treatment duration should be based on patient characteristics, including risk of bleeding and myocardial ischemia 3.
- Patients at high risk of bleeding may require a shorter duration of DAPT, while those at low risk of bleeding may benefit from prolonged DAPT 3.
- The optimal duration of DAPT beyond 1 year is not well established, and further studies are needed to determine the best treatment strategy for individual patients 3.