Ticagrelor has some advantages over prasugrel. In fact, compared with clopidogrel, ticagrelor and prasugrel were found to reduce the same composite endpoint by 16% and 24%, respectively. These pharmacokinetic and pharmacodynamic advantages translate to greater outcome improvement. Ticagrelor and prasugrel have a faster onset of action and provide greater and more consistent platelet inhibition. Another limitation of clopidogrel is its irreversible platelet inhibition. The efficacy of clopidogrel, however, is limited by the delayed onset of its effect (several hours after ingestion), secondary to the slow biotransformation from prodrug to the active metabolite, as well as by the substantial interpatient variability in the response to the drug. Ticagrelor, 180 mg loading dose, then 90 mg twice daily (level of evidence: B)Ĭompared with aspirin alone, clopidogrel was found to reduce the incidence of a composite endpoint of CV death, nonfatal MI, and stroke at 30 days by 20%. Prasugrel, 60 mg loading dose, then 10 mg/day (level of evidence: B)