[Medication of the month. Ticagrelor (Brilique): potent oral antagonist of platelet activity].

Dual antiplatelet therapy with clopidogrel combined with aspirin reduces ischemic events in acute coronary syndromes (ACS). The individual response to clopidogrel is, however, very variable from one subject to another, and the risk of events seems higher when platelet inhibition is insufficient. Ticagrelor is a potent oral inhibitor of platelet activity. It binds reversibly to the P2Y12 adenosine diphosphate. The platelet inhibition that it induces is faster and more pronounced than that of clopidogrel. In patients who have an ACS (PLATO study) with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke, without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding. In Belgium, Brilique is currently indicated in combination with aspirin for the prevention of atherothrombotic events in patients with ACS.