What it's for (Indications)
- Ticagrelor, in conjunction with aspirin, is indicated for the prevention of atherothrombotic events in patients with Acute Coronary Syndrome (ACS), history of myocardial infarction (MI), Coronary Artery Disease (CAD) without prior stroke or MI, and for acute ischemic stroke.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | Ticagrelor should be used with a daily maintenance dose of aspirin (75-100 mg). For Acute Coronary Syndrome (ACS) or history of Myocardial Infarction (MI), initiate with a 180 mg oral loading dose, followed by 90 mg twice daily for the first year, then 60 mg twice daily thereafter. For patients with Coronary Artery Disease (CAD) and no prior stroke or MI, administer 60 mg twice daily. For acute ischemic stroke, initiate with a 180 mg loading dose, then continue with 90 mg twice daily for up to 30 days. If a dose is missed, patients should take their next dose at its regularly scheduled time. For patients unable to swallow tablets whole, ticagrelor tablets can be crushed, mixed with water, and administered orally. For patients who have undergone PCI, single antiplatelet therapy with ticagrelor may be considered based on the evolving risk for thrombotic versus bleeding events. |
Safety & Warnings
Common Side Effects
- Common adverse reactions include bleeding (e.
- g.
- , nose bleeds) and dyspnea (shortness of breath), which are reported in more than 5% of patients.
- Other potential side effects include dizziness.
Serious Warnings
- Black Box Warning: WARNING: BLEEDING RISK. Ticagrelor, like other antiplatelet agents, can cause significant, sometimes fatal bleeding. Do not use ticagrelor in patients with active pathological bleeding or a history of intracranial hemorrhage. Do not start ticagrelor in patients undergoing urgent coronary artery bypass graft (CABG) surgery. If possible, manage bleeding without discontinuing ticagrelor. Stopping ticagrelor may increase the risk of thrombotic events.
- Patients should undergo regular kidney function tests.
- Caution is advised for patients with liver impairment.
- Ticagrelor, like other antiplatelet agents, carries a significant, sometimes fatal, risk of bleeding.
- Dyspnea is also a notable adverse reaction.
- Do not initiate ticagrelor in patients undergoing urgent coronary artery bypass graft surgery (CABG).
- If possible, manage bleeding events without discontinuing ticagrelor, as abrupt cessation may increase the risk of thrombotic events.
- Ticagrelor is contraindicated in pregnancy and should not be used during lactation.
How it Works (Mechanism of Action)
Ticagrelor and its major metabolite reversibly interact with the platelet P2Y 12 ADP-receptor to prevent signal transduction and platelet activation. Ticagrelor and its active metabolite are approximately equipotent.