Aim: This purpose of this study was to compare the effects of clopidogrel and ticagrelor in cases of antiplatelet therapy for treating acute coronary syndromes

Study design: retrospective longitudinal comparative study

Place and duration: This Study was conducted at Sandeman Provincial Hospital Quetta, Pakistan over a period of  two years, from February 2019 to July 2021

Methodology: A study population of 1002 patients was taken, each diagnosed with acute coronary syndrome. The inclusion criteria for these patients included that they had been previously treated with antiplatelet therapy and had been subject to invasive therapy and management. The multiplate analyzer was used to measure the platelet count for each patient. Patient history was taken and the response of each patient to the medication was recorded throughout the interval of one year. The outcome after one year on the medication was also noted and analyzed.

Results: Ticagrelor was given to patients who were young and possessed a lesser chance of having diabetes. These patients also presented with an elevated ST segment or had previously suffered from a myocardial infarction, the p value was recorded to be greater than 0.05. It was noted that patients who were treated with ticagrelor had a lower risk score of bleeding. Patients who were treated with ticagrelor also showed a lower risk score for the global registry of acute coronary events (grace) where the results showed that patients treated with ticagrelor had a score of 121 ± 27 versus 127± 31.5 and the p value was equated as 0.002.

There were greatly reduced results for the high platelet reactivity in patients treated with ticagrelor. When patients treated with clopidogrel were compared with patients treated with ticagrelor the high platelet reactivity results showed that it was 37.5% versus 16.7% respectively with the p-value of less than 0.0001.

Conclusion: The results from the study concluded that in case of patients who were categorized as lower risk, ticagrelor was prescribed more frequently, but it was not prescribed as frequently in the case of higher risk patients. Ticagrelor was also discontinued in case of side effects such as bleeding, trouble breathing or bradyarrythmia. However, these side effects were not common. Discontinuation rates were higher after most cases of coronary artery bypass graft surgery. These higher discontinuation rates were noted in patients who were treated without the use of revascularization. There is a need for more research to be done on this and educating surgeons on the benefits and pitfalls of the medication and its effects is also needed.

Keywords: Ticagrelor, clopidogrel, acute coronary syndromes. comparison