Background

Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor inhibitor remains the cornerstone of pharmacological management following percutaneous coronary intervention (PCI). Ticagrelor, a potent reversible P2Y12 inhibitor, has demonstrated superior platelet inhibition compared with clopidogrel. However, concerns regarding bleeding complications, dyspnea, and cost continue to influence clinical decision-making.

Objective

To compare the effectiveness and safety of ticagrelor versus clopidogrel in patients undergoing PCI for acute coronary syndrome (ACS) and stable coronary artery disease.

Methods

A prospective multicenter observational study included 1,200 patients undergoing PCI between January 2020 and December 2024. Patients received either ticagrelor-based DAPT (n=620) or clopidogrel-based DAPT (n=580). Primary outcomes included major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis, stroke, mortality, and bleeding complications during 12-month follow-up.

Results

Ticagrelor significantly reduced MACE compared with clopidogrel (7.4% vs. 11.2%, p=0.018). Rates of myocardial infarction and definite stent thrombosis were lower in the ticagrelor group. However, major bleeding occurred more frequently among ticagrelor-treated patients (4.0% vs. 2.1%, p=0.041). All-cause mortality was significantly reduced with ticagrelor (2.4% vs. 4.1%, p=0.033).

Conclusion

Ticagrelor demonstrated superior ischemic protection and lower mortality compared with clopidogrel after PCI, albeit with a modest increase in bleeding risk. These findings support the preferential use of ticagrelor in patients at high ischemic risk and acceptable bleeding risk.