Bleeding Risk Comparison of Plavix and Brillinta

Overall Bleeding Risk

• The American College of Cardiology recommends ticagrelor or prasugrel over clopidogrel for ACS patients undergoing PCI, but this must be balanced against individual bleeding risk 7
• The European Society of Cardiology recommends ticagrelor over clopidogrel unless bleeding risk outweighs ischemic benefit 2
• Ticagrelor significantly increases non-CABG major bleeding compared to clopidogrel, representing an 18% relative increase in bleeding risk 2, 3, 1
• Ticagrelor causes more non-procedure-related major bleeding 3
• Fatal intracranial bleeding is higher with ticagrelor 4

Clinical Decision Algorithm for Agent Selection

• The American Heart Association recommends choosing clopidogrel in patients with a history of gastrointestinal bleeding, as it is strongly preferred over ticagrelor in this population 1
• The European Society of Cardiology recommends choosing clopidogrel in patients aged 75 years or older with multiple bleeding risk factors 5
• The American College of Cardiology recommends choosing ticagrelor in standard ACS patients without high bleeding risk 7

Bleeding Risk Mitigation Strategies

• The American College of Cardiology recommends prescribing a proton pump inhibitor with DAPT in all patients, as this is a Class I recommendation 7, 2, 8, 1
• The European Society of Cardiology recommends maintaining aspirin dose at 75-100 mg daily when combined with either P2Y12 inhibitor 2, 8
• The American College of Cardiology recommends using radial artery access over femoral access for PCI when performed by an experienced radial operator 2, 8