Ticagrelor versus clopidogrel in patients with acute coronary ...

Background
CABG
• In NSTEMI and STEMI ACS, guidelines recommend 12 months’
treatment with aspirin and clopidogrel
• Clopidogrel is currently the standard of care but is hampered by
– slow and variable transformation to the active metabolite
– modest and variable platelet inhibition
– risk of stent thrombosis and MI in poor responders
– irreversible effect – increased risk of bleeding at urgent CABG
• Clopidogrel is recommended to be withdrawn 5 days prior to CABG
but clinical reality often requires surgery earlier
PLATO = PLATelet inhibition and patient Outcomes; NSTEMI = non-ST segment elevation; STEMI = ST segment elevation;
ACS = acute coronary syndromes; MI = myocardial infarction; CABG = coronary artery bypass graft