What are the differences between ticagrelor and clopidogrel, commonly used drugs for coronary heart disease?

For patients with acute coronary syndrome and those after PCI, dual-antibody therapy is the basis of antithrombotic therapy. Among them, aspirin combined with a P2Y12 receptor inhibitor is commonly used in clinical practice. The most commonly used P2Y12 receptor inhibitors are clopidogrel and ticagrelor. So, as first-line P2Y12 receptor antagonists, what are the differences between the two? Today, one article explains it clearly.

1. Different ways of binding to platelets

Clopidogrel binds to platelets in an irreversible way, which reduces the number of platelets during medication, and blood transfusions are needed to replenish platelets when bleeding occurs. However, ticagrelor binds to platelets in a reversible way, which means that platelets will recover after stopping the drug.

2. Different onset times

As we all know, clopidogrel is a prodrug that can only be converted into active metabolites under the action of the liver enzyme CYP2C19. However, both ticagrelor and its main metabolites are active, so ticagrelor takes effect faster.

3. Antiplatelet Strength

Ticagrelor has a stronger antiplatelet effect than clopidogrel. At least within the first 12 months after the onset of acute coronary syndrome, the efficacy of ticagrelor is better than clopidogrel, and clopidogrel should only be used in patients who cannot tolerate ticagrelor.

4. Different metabolic enzyme subtypes

Clopidogrel is a prodrug that is mainly metabolized by the hepatic enzyme CYP2C19, while ticagrelor is mainly metabolized by CYP3A4, and a small part by CYP3A5.

5. Bleeding Risk

Clopidogrel and ticagrelor are both antiplatelet drugs, and both have the risk of causing bleeding. Studies have shown that the risk of bleeding with long-term use of ticagrelor is higher than that with clopidogrel, but in the case of short-term use, the risk of bleeding with the two is similar.