Ticagrelor: Pharmacokinetics, Pharmacodynamics, Clinical Efficacy, and Safety

• Published in: Pharmacotherapy 2014-10, Vol.34 (10), p.1077-1090
• Main Authors: Dobesh, Paul P., Oestreich, Julie H.
• Format: Article
• Language: English
• Subjects: ACS; acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Adenosine - adverse effects; Adenosine - analogs & derivatives; Adenosine - pharmacokinetics; Adenosine - therapeutic use; Angina pectoris; Animals; antiplatelets; Biological and medical sciences; CAD; Cardiology. Vascular system; Clinical Trials as Topic - methods; coronary artery disease; Coronary heart disease; Drug therapy; Heart; Humans; Medical sciences; Myocarditis. Cardiomyopathies; P2Y12 inhibitors; Pharmacology. Drug treatments; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - pharmacokinetics; Purinergic P2Y Receptor Antagonists - therapeutic use; Reviews of Therapeutics; Thrombosis - blood; Thrombosis - chemically induced; Ticagrelor; Treatment Outcome
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1477

Dual antiplatelet therapy, composed of aspirin plus a P2Y12‐receptor antagonist, is the cornerstone of treatment for patients with acute coronary syndrome (ACS). A number of U.S. Food and Drug Administration–approved P2Y12‐receptor antagonists are available for treating patients with ACS, including the thienopyridine compounds clopidogrel and prasugrel. Ticagrelor, the first of a new class of antiplatelet agents, is a noncompetitive, direct‐acting P2Y12‐receptor antagonist. Unlike the thienopyridine compounds, ticagrelor does not require metabolism for activity. Also, whereas clopidogrel and prasugrel are irreversible inhibitors of the P2Y12 receptor, ticagrelor binds reversibly to inhibit receptor signaling and subsequent platelet activation. In pharmacodynamic studies, ticagrelor demonstrated faster onset and more potent inhibition of platelet aggregation than clopidogrel. These properties of ticagrelor may contribute to reduced rates of thrombotic outcomes compared with clopidogrel, as demonstrated in a phase III clinical trial. However, in addition to bleeding, distinctive adverse effects of this new chemical entity have not been reported with the thienopyridine P2Y12‐receptor inhibitors. Although ticagrelor represents an advancement in P2Y12‐receptor inhibition therapy, a thorough understanding of this compound as an antiplatelet therapy remains to be elucidated.