WSC 2025 | Antiplatelet agents in patients with TIA and minor stroke: the shift from clopidogrel to ticagrelor

So, we are actually at an interesting crossroad. Clopidogrel has been used as the antiplatelet agent, an ADP blocker, a P2Y12 receptor blocker, and there is actually another agent that has been tried in clinical trials with ticagrelor, or also called Brilinta. Now, the reason, even though ticagrelor may have certain properties of the drug that may be more desirable than clopidogrel, it actually hasn’t been used more frequently. And the main reason was the cost. So clopidogrel was a generic medication and ticagrelor was still on a patent, still was under a patent. So obviously there was a major difference in cost. So despite a new drug that could potentially have a better pharmacokinetic profile, clopidogrel was used for pure cost. So now ticagrelor is going to become generic, which means that we will be using more of ticagrelor. And the question will become, are these findings also valid when we’re using ticagrelor and aspirin? So essentially, somebody who’s on ticagrelor, should we still also favor using a lower dose of aspirin. I think that, you know, although the data is not conclusive because there’s not that many studies in patients with transient ischemic attack and ischemic stroke using ticagrelor and aspirin, but the general thought has been that these findings should be extrapolated. So patients who are going to be placed on ticagrelor should also be on a lower dose of aspirin preferentially. So I think that’s the next step that perhaps through a different set of observations, these findings would have to be validated when ticagrelor becomes the major drug as opposed to clopidogrel in stroke patients.

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