Ticagrelor

Ticagrelor (trade name Brilinta, Brilique, and Possia) is a platelet aggregation inhibitor produced by AstraZeneca. Ticagrelor (trade name Brilinta, Brilique, and Possia) is a platelet aggregation inhibitor produced by AstraZeneca. Ticagrelor is an antagonist of the P2Y12 receptor. The drug was approved for use in the European Union by the European Medicines Agency on December 3, 2010. The drug was approved by the US Food and Drug Administration on July 20, 2011. Ticagrelor is used for the prevention of thrombotic events (for example stroke or heart attack) in different categories of patients. The drug is combined with acetylsalicylic acid unless the latter is contraindicated. There is no high quality evidence for the use of ticagrelor before percutaneous coronary intervention (PCI) in non-ST elevation acute coronary syndrome. The FDA indication for ticagrelor is reduction of the rate of cardiovascular death, myocardial infarction (MI), and stroke in people with acute coronary syndrome or history of myocardial infarction. According ESC 2017 guidelines, ticagrelor is the first-option treatment in patients with acute coronary syndrome with or without ST segment elevation, irrespective of treatment strategy (invasive or non-invasive) - IB level of evidence. The 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy provides similar recommendations, although with the lower level of evidence - IIaB. Furthermore, the 2017 ESC Focused Update on Duration of Dual Antiplatelet Therapy allows physicians to administer ticagrelor to patients with stable coronary artery disease undergoing percutaneous coronary intervention after taking thrombotic and haemorrhagic risk into consideration. Ticagrelor was found to be comparable to aspirin in people with acute ischemic stroke or transient ischemic attack. A study published in JAMA reveals antibacterial activity in conventional anti platelet dose against antibiotic-resistant gram-positive bacteria which needs further randomized trails for use as antibiotic. Another study compared ticagrelor and clopidogrel in patients with acute coronary syndrome (PLATO Trial) revealed that patients treated with Ticagrelor had a lower risk of infection-related deaths. The Targeting Platelet-Leukocyte Aggregates in Pneumonia With Ticagrelor (XANTHIPPE) study showed improvement in lung function in patients hospitalized for pneumonia in patients using ticagrelor. Contraindications for ticagrelor are: active pathological bleeding and a history of intracranial bleeding, as well as reduced liver function and combination with drugs that strongly influence activity of the liver enzyme CYP3A4, because the drug is metabolized via CYP3A4 and excreted via the liver.