Considerable progress has been achieved over the past decade in the treatment of acute coronary syndromes (ACS): ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. With expeditious revascularization recognized as the cornerstone of the treatment of ACS, selecting the optimum pharmacotherapeutic regimen to support the invasive approach becomes imperative. Because platelet activation is intense in ACS, percutaneous coronary intervention, and coronary artery bypass graft surgery, the thienopyridine clopidogrel, which inhibits ADP-induced platelet activation, when added to acetylsalicylic acid further suppresses ischemic complications in ACS. Ticagrelor, an oral reversible non-thienopyridine cyclo-pentyltriazolo-pyrimidine direct-acting inhibitor of the adenosine diphosphate receptor P2Y12. In the PLATO trial, ticagrelor was compared with clopidogrel regarding efficacy and safety in more than 18 624 patients with ACS. In patients who had ACS with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding. These results support ticagrelor as a new standard of care in ACS.
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