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Is ticagrelor better than clopidogrel?

Medically reviewed by Carmen Pope, BPharm. Last updated on May 19, 2025.

Official Answer by Drugs.com

Current guidelines issued by the American Heart Association/American College of Cardiology recommend ticagrelor (or prasugrel) over clopidogrel for dual antiplatelet therapy in conjunction with aspirin in patients with acute coronary syndrome (ACS)/ST‐segment–elevation myocardial infarction (STEMI).

Other differences between ticagrelor and clopidogrel include:

How does ticagrelor work?

Ticagrelor works in a different way to other antiplatelet agents, such as aspirin, clopidogrel, and prasugrel. Although it still blocks a substance called ADP (adenosine-5-diphosphate) which plays a crucial role in blood clotting, it does it by reversibly binding to a receptor called P2Y12 on the platelet surface. Reversible binding means platelet activity is restored once concentrations of ticagrelor decrease below a certain level, in contrast to other antiplatelet agents such as clopidogrel and prasugrel which bind irreversibly for the life of the platelet.

Ticagrelor works more quickly than clopidogrel. Within 30 minutes, a 180mg loading dose of ticagrelor inhibited 41% of platelets. It takes almost 8 hours for clopidogrel 600mg to achieve this same effect.


Maximum platelet inhibition (88% inhibition) was reached two hours after a dose of ticagrelor. Crushing tablets and then administering them appears to hasten the time to peak concentrations.

After administration of one dose of ticagrelor, maximum platelet inhibition is achieved at two hours and lasts for another six hours (eight hours total). 24 hours after a dose of ticagrelor, platelet inhibition is still 58%. It takes 56 hours (over 2 days) for platelet inhibition to drop to 56% and 110 hours (over 4 days) for platelet inhibition to drop to 10%.

How does clopidogrel work?

Clopidogrel binds irreversibly to P2Y12 receptors on the platelet surface, which blocks a substance called ADP (adenosine-5-diphosphate) which plays a crucial role in blood clotting. Platelets are blocked from aggregating for the remainder of their lifespan (about seven to 10 days).

References
  • Ticagrelor 03/2020 Drugs.com https://www.drugs.com/ppa/ticagrelor.html
  • Dobesh PP, Oestreich JH. Ticagrelor: pharmacokinetics, pharmacodynamics, clinical efficacy, and safety. Pharmacotherapy. 2014;34(10):1077-1090. doi:10.1002/phar.1477
  • Levine GN, Bates ER, Bittl JA, etal. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2016; 134:e123–e155.
  • Clopidogrel Drugs.com https://www.drugs.com/ppa/clopidogrel.html
  • Sangkuhl K, Klein TE, Altman RB. Clopidogrel pathway. Pharmacogenet Genomics. 2010;20(7):463-465. doi:10.1097/FPC.0b013e3283385420
  • Sangkuhl K, Klein TE, Altman RB. Clopidogrel pathway. Pharmacogenet Genomics. 2010;20(7):463-465. doi:10.1097/FPC.0b013e3283385420
  • Berger JS. Aspirin, clopidogrel, and ticagrelor in acute coronary syndromes. Am J Cardiol. 2013;112(5):737-745. doi:10.1016/j.amjcard.2013.04.055
  • Wang D, Yang XH, Zhang JD, Li RB, Jia M, Cui XR. Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):217. Published 2018 Nov 29. doi:10.1186/s12872-018-0948-4
  • Brilinta (ticagrelor) Medical News Today. https://www.medicalnewstoday.com/articles/326968#dosage
  • Wang D, Yang XH, Zhang JD, Li RB, Jia M, Cui XR. Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):217. Published 2018 Nov 29. doi:10.1186/s12872-018-0948-4
  • Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST-Segment–Elevation Myocardial Infarctions. Journal of the American Heart Association. 2019:18(8)

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