Hematology · USMLE Step 1 and Step 2

Clopidogrel & Ticagrelor song

Clopidogrel & Ticagrelor - Mechanism & Uses, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Clopidogrel & Ticagrelor

Full song on YouTube ↗Spotify ↗

Key points in this song10

Clopidogrel and ticagrelor are P2Y12 ADP receptor antagonists that irreversibly (clopidogrel) or reversibly (ticagrelor) inhibit platelet aggregation by blocking ADP-mediated GPIIb/IIIa activation.
Clopidogrel is a prodrug requiring hepatic conversion by CYP2C19; loss-of-function CYP2C19 polymorphisms ("poor metabolizers") reduce efficacy and increase cardiovascular events.
Ticagrelor does not require hepatic activation and has faster onset and greater platelet inhibition than clopidogrel, making it preferred in ACS per ACC/AHA guidelines.
Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 inhibitor is standard of care for acute coronary syndrome and post-PCI stent placement to prevent in-stent thrombosis.
Ticagrelor's unique adverse effects include dyspnea (adenosine reuptake inhibition) and ventricular pauses; it is contraindicated with high-dose aspirin (>100 mg/day) due to reduced efficacy.
Clopidogrel is contraindicated with omeprazole (CYP2C19 inhibitor), which reduces its antiplatelet effect; pantoprazole is the preferred PPI alternative.
Both agents are held 5 days (clopidogrel) or 5 days (ticagrelor) before elective surgery to reduce bleeding risk; prasugrel requires 7 days.
Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening complication associated with clopidogrel use, presenting with microangiopathic hemolytic anemia and thrombocytopenia.
Ticagrelor is contraindicated in patients with prior intracranial hemorrhage or active pathological bleeding, and dose adjustment is unnecessary in renal impairment unlike clopidogrel.
Loading doses are used in ACS: clopidogrel 300–600 mg and ticagrelor 180 mg, followed by maintenance doses of 75 mg/day and 90 mg twice daily, respectively.