Prescribing ticagrelor to treat acute coronary syndromes

Abstract

Acute coronary syndromes are a leading cause of mortality and morbidity in the UK. The underlying pathology is rupture or fissure of a coronary atherosclerotic plaque, which leads to thrombus formation. This results in a restriction or occlusion of coronary blood flow and the resultant presentation of an acute coronary syndrome. Platelets play a pivotal role in this pathophysiological process and are the focus of pharmacological therapy. Ticagrelor is an anti-platelet agent that inhibits the activation of the glycoprotein IIb/IIIa receptors on the platelet and therefore prevents platelet aggregation and thrombus formation. The PLATelet inhibition and patient Outcomes Trial ( Wallentin et al, 2009 ) demonstrated superiority over clopidogrel in the reduction of major adverse cardiovascular events, including mortality. Common adverse effects include bleeding, dyspnoea and ventricular pauses. Maintenance dosing involves twice-daily administration, which poses a risk of noncompliance. Patient education is essential to promoting an effective treatment regimen and reducing the risk of adverse events.