Ticagrelor
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Ticagrelor is a direct-acting, reversible P2Y12 receptor inhibitor that does not require hepatic activation. The PLATO trial demonstrated superiority over clopidogrel in reducing cardiovascular events in ACS patients. Unlike thienopyridines, its binding is reversible, allowing faster recovery of platelet function after discontinuation.
Exploratory record, not a reviewed medical publication.
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What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Ticagrelor is a direct-acting, reversible P2Y12 receptor inhibitor that does not require hepatic activation. NutriStack rates the supporting evidence as strong. Common adult dosing is 180 mg loading dose, then 90 mg twice daily for 12 months (with aspirin 75–100 mg daily) (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.
- Bleeding
- Dyspnea (dose-related, usually mild and self-limiting)
- Bradycardia and ventricular pauses (usually asymptomatic)
- Active pathological bleeding
- History of intracranial hemorrhage
The bottom line
Evidence rating strong. Most-documented uses: superior to clopidogrel in acs (plato trial), faster onset and offset than clopidogrel, no dependence on cyp2c19 metabolism. 10 sources indexed (2018–2026), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Cyclopentyl-triazolopyrimidine that directly and reversibly binds the P2Y12 ADP receptor at a site distinct from the ADP binding site (allosteric inhibition). Does not require metabolic activation, providing faster and more consistent platelet inhibition than clopidogrel. Also inhibits adenosine reuptake via equilibrative nucleoside transporter-1 (ENT-1), which may contribute to vasodilatory and anti-inflammatory effects.
Dosing & protocol.
Can be taken with or without food; tablets can be crushed and mixed with water for NG tube administration8
Full safety detail.
Side effects
- Bleeding
- Dyspnea (dose-related, usually mild and self-limiting)
- Bradycardia and ventricular pauses (usually asymptomatic)
- Elevated uric acid and serum creatinine
- Headache
- Bruising
Contraindications
- Active pathological bleeding
- History of intracranial hemorrhage
- Severe hepatic impairment
- Concurrent strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin)
- Concurrent strong CYP3A4 inducers (rifampin, phenytoin, carbamazepine)
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
5- 1Ticagrelor Versus Clopidogrel or Aspirin in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled TrialsPMIDZaihan AF, Mohamad Hafiz NAH, Tong YS et al. · Stroke research and treatment · 2026
Zaihan AF, Mohamad Hafiz NAH, Tong YS et al.. Ticagrelor Versus Clopidogrel or Aspirin in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Stroke research and treatment. 2026
- 2De-escalating Dual Antiplatelet Therapy to Ticagrelor Monotherapy in Acute Coronary Syndrome : A Systematic Review and Individual Patient Data Meta-analysis of Randomized Clinical TrialsPMIDLee YJ, Gao X, Lee SH et al. · Annals of internal medicine · 2025
Lee YJ, Gao X, Lee SH et al.. De-escalating Dual Antiplatelet Therapy to Ticagrelor Monotherapy in Acute Coronary Syndrome : A Systematic Review and Individual Patient Data Meta-analysis of Randomized Clinical Trials. Annals of internal medicine. 2025
- 3A comparison of the effects of ticagrelor and clopidogrel in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trialsPMIDGeravandi M, Nourabi M, Navabifar S et al. · BMC pharmacology & toxicology · 2024
Geravandi M, Nourabi M, Navabifar S et al.. A comparison of the effects of ticagrelor and clopidogrel in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trials. BMC pharmacology & toxicology. 2024
- 4Ticagrelor for patients undergoing coronary artery bypass grafting: A meta-analysis of randomized controlled trialsPMIDXiang F, Lin Y, Chen B · Perfusion · 2023
Xiang F, Lin Y, Chen B. Ticagrelor for patients undergoing coronary artery bypass grafting: A meta-analysis of randomized controlled trials. Perfusion. 2023
- 5Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: a meta-analysis of randomized trialsPMIDWu B, Lin H, Tobe RG et al. · Journal of comparative effectiveness research · 2018
Wu B, Lin H, Tobe RG et al.. Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: a meta-analysis of randomized trials. Journal of comparative effectiveness research. 2018
Reference material
5- 6Wallentin L et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes (PLATO). N Engl J Med. 2009.Source linkedPMID
- 7Bonaca MP et al. Long-term use of ticagrelor in patients with prior myocardial infarction (PEGASUS-TIMI 54). N Engl J Med. 2015.Source linkedPMID
- 8Zheng L et al. Efficacy and safety of off-label low-dose compared with standard-dose antiplatelet agents in patients with coronary heart disease: a meta-analysis. Open Heart. 2026.Source linkedPMID
- 9Valgimigli M, Gragnano F, Branca M et al.. Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Patient-Level Meta-Analysis. JAMA cardiology. 2024Source linkedPMID
- 10Valgimigli M, Hong SJ, Gragnano F et al.. De-escalation to ticagrelor monotherapy versus 12 months of dual antiplatelet therapy in patients with and without acute coronary syndromes: a systematic review and individual patient-level meta-analysis of randomised trials. Lancet (London, England). 2024Source linkedPMID
Common questions.
Quick answers about Ticagrelor, drawn from the data on this page.
What is Ticagrelor?
Ticagrelor is a direct-acting, reversible P2Y12 receptor inhibitor that does not require hepatic activation. The PLATO trial demonstrated superiority over clopidogrel in reducing cardiovascular events in ACS patients. Unlike thienopyridines, its binding is reversible, allowing faster recovery of platelet function after discontinuation.
What is Ticagrelor used for?
Commonly cited benefits of Ticagrelor include: Superior to clopidogrel in ACS (PLATO trial); Faster onset and offset than clopidogrel; No dependence on CYP2C19 metabolism; Reversible binding allows faster platelet recovery. NutriStack rates the overall evidence as strong.
What is a typical dose of Ticagrelor?
A typical adult dose of Ticagrelor is 180 mg loading dose, then 90 mg twice daily for 12 months (with aspirin 75–100 mg daily) (as prescribed by your physician). The commonly recommended form is Oral tablet. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Ticagrelor?
Reported side effects include bleeding, dyspnea (dose-related, usually mild and self-limiting), bradycardia and ventricular pauses (usually asymptomatic), elevated uric acid and serum creatinine, headache, bruising. This is educational information; check with a healthcare professional before use.
How strong is the evidence for Ticagrelor?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Ticagrelor in NutriStack.
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