Ticagrelor: molecular discovery to clinical evidence

Abstract

1.Acute coronary syndrome e global and Indian perspective Cardiovascular death (CVD) is one of the leading causes in the non-communicable disease (NCD) deaths. According to WHO estimates around 17 million people die of CVD each year, 1 out of which coronary heart disease (CHD) accounts for 7.1 million deaths. Developing countries like India are witnessing economic transition, urbanization and industrialization resulting in major lifestyle changes like increased tobacco use, physical inactivity and unhealthy diet, that has lead to a dramatic increase in CVD and CHD. 2 In Indian context, there are many challenges in managing patients of ACS. ACS patients in India die younger and sicker with average age at 57 years, almost 10e15 years younger than in west. Moreover, they carry high risk factor profile that includes Diabetes, Hypertension, Smoking and Dyslipidemia and close to 20% patients suffer from a 2nd heart attack in India. 3 As per CREATE registry 60% of patients in India were of STEMI whereas as per global registry data 40% patients were of STEMI. This implies that patients admitted to Indian hospitals with acute coronary syndromes are likely to have a worse prognosis than those in developed countries. In spite of being at high risk, in India, <10% ACS patients are managed through PCI with less than 15% receiving DAPT. 3 Experience in the developed world has shown that significant reductions in CAD prevalence and mortality can be

Snapshot of the prescribing practice for the clopidogrel and esomeprazole coprescription and cost evaluation of the application guidelines

“…Moreover, unlike clopidogrel and prasugrel, ticagrelor does not require metabolic activation; therefore, the interindividual variability in response to ticagrelor is lower. This advantage has to be balanced with the increased risk of dyspnea (Sinha ; Serebruany et al. ).…”

“…Moreover, unlike clopidogrel and prasugrel, ticagrelor does not require metabolic activation; therefore, the interindividual variability in response to ticagrelor is lower. This advantage has to be balanced with the increased risk of dyspnea (Sinha 2012;Serebruany et al 2014). However, these switches would cause a significant extra cost for the hospital because generic clopidogrel has been listed in the HUG drug formulary since November 2011 at a negotiated price, and prasugrel and ticagrelor are not.…”

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“…The PLOTO trial compare ticagrelor with clopidogrel in which the primary composite endpoints, stroke, MI, Cardiovascular death and stent thrombosis and were reduced in patients with ACS. The benefit of ticagrelor appears to be attenuated in patients with lowering body weight and not taking lipid lowering drugs 13,14 .…”

Dental Management and Bleeding Complications of Patients on Long-Term Oral Antiplatelet Therapy. Review of Existing Studies and Guidelines.

“…The drug is combined with acetylsalicylic acid unless the latter is contraindicated. [5,7] Phosphodiesterase inhibitors Dipyridamole Dipiridamole inhibits the cellular reuptake of adenosine into platelets, red blood cells and endothelial cells leading to increased extracellular concentrations of adenosine.…”