Ticagrelor: molecular discovery to clinical evidence

Cardiovascular (CV) deaths are one of the leading cause of death, both in developed and developing countries, with acute coronary syndrome (ACS) accounting for about 50% of all CV deaths. Atherothrombosis formation is the prime reason behind ACS and platelets play a central role in formation of thrombus. Antiplatelet drugs, particularly dual antiplatelet therapy (DAPT) with Aspirin and Clopidogrel play a vital role and are widely used in the management of ACS for the past decade. However in spite of currently available options for antiplatelet therapy there remains a significant risk of arterial thrombosis and post ACS mortality grows over a period of time. Thus, there is a need for novel antiplatelet agents which can overcome some limitations of current antiplatelet therapies. Ticagrelor is a novel antiplatelet agent which has a faster onset of action, produces high level of platelet inhibition with minimal inter patient variability. This review summarizes the pharmacokinetic, pharmacodynamic characteristics and clinical evidence of ticagrelor in the management of ACS.