The Medical Letter on Drugs and Therapeutics
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Ticagrelor (Brilinta) - Better than Clopidogrel (Plavix)?

The FDA has approved ticagrelor (Brilinta – AstraZeneca), an oral antiplatelet drug, for use with low-dose aspirin to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS). It will compete with clopidogrel (Plavix) and prasugrel (Effient) for such use.1 Clopidogrel is expected to become available generically in the US within the next few months.

STANDARD TREATMENT — Aspirin plus clopidogrel or prasugrel is the standard of care for antiplatelet therapy in patients with ACS (unstable angina [UA], non-ST elevation myocardial infarction [NSTEMI], acute MI [STEMI] or percutaneous coronary intervention [PCI]).

Clopidogrel is a prodrug that requires conversion to an active form; genetic polymorphisms and some other drugs may interfere with its activation.2,3 The antiplatelet ... more      

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