ticagrelor (Brilinta)

introduction

a reversible adenosine diphosphate P2Y12 inhibitor marketed in Australia in 2011 as Brilinta 90mg tablets
approved on PBS from August 2012 following the PLATO trial which showed in patients with acute coronary syndromes including STEMI:
- significantly greater reduction in cardiovascular death, AMI or stroke when compared to clopidogrel:
  - 9.8% vs 11.7% at 12 months, p<0.001 = relative risk reduction of 16% and absolute risk reduction of 1.9%
  - the difference was mainly due to reduced CV death and AMI as stroke rates were similar
- no significant difference in major (11.6%) or life threatening bleeding (5.8%) compared to clopidogrel
- however, more patients developed SOB (13.8% vs 7.8%), and more discontinued Rx (2.9% vs 1.2%)
give with aspirin 75-150 mg/day.
in 2025, an investigational monoclonal antibody called bentracimab was shown to safely and effectively reverse potentially catastrophic bleeding complications linked to ticagrelor with platelet function quickly and significantly restored within minutes in all patients in the study ¹⁾ - awaiting approval

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