- Question
- Is ticagrelor, a reversible P2Y12 receptor inhibitor, superior to clopidogrel for preventing cardiovascular events in patients hospitalized with an acute coronary syndrome?
- Design
- Multicenter, randomized, double-blind phase 3 trial enrolling 18624 patients, with 12 months of follow-up.
- Population
- Patients admitted to hospital with an acute coronary syndrome, with or without ST-segment elevation.
- Intervention
- Ticagrelor with a 180-mg loading dose, followed by 90 mg twice daily.
- Control
- Clopidogrel with a 300-to-600-mg loading dose, followed by 75 mg once daily.
- Primary outcome
- Composite of death from vascular causes, myocardial infarction, or stroke at 12 months.
- Results
- The primary end point occurred in 9.8% with ticagrelor versus 11.7% with clopidogrel (HR 0.84; 95% CI 0.77 to 0.92; P<0.001). Death from any cause was also lower with ticagrelor (4.5% vs. 5.9%; P<0.001).
- Safety
- There was no significant difference in overall major bleeding (11.6% vs. 11.2%; P=0.43), but ticagrelor was associated with more major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%; P=0.03), with more fatal intracranial bleeding and fewer fatal bleeds of other types.
- Conclusion
- In patients with an acute coronary syndrome, ticagrelor reduced major vascular events compared with clopidogrel, without increasing overall major bleeding but with more non-procedure-related bleeding.
- Why it matters
- It showed that faster and more potent platelet inhibition could improve clinical outcomes over clopidogrel, and established ticagrelor as a leading alternative for antiplatelet therapy in acute coronary syndrome.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026