aspirin and ticagrelor

Both aspirin and ticagrelor inhibit platelet function through different pathways, resulting in additive antiplatelet effects and an increased risk of bleeding. Aspirin irreversibly inhibits cyclo-oxygenase-1, reducing thromboxane A2 production, while ticagrelor reversibly blocks the P2Y12 receptor, preventing ADP-induced platelet activation.

Co-administration significantly increases the risk of bleeding events, including gastrointestinal haemorrhage and intracranial haemorrhage. This combination is often used intentionally in the management of acute coronary syndromes, but the benefit must outweigh the bleeding risk in each patient.

Use the combination only when indicated, such as in acute coronary syndromes or after stent placement. Monitor patients closely for signs of bleeding, including occult blood loss. Consider gastroprotective strategies such as proton pump inhibitors in patients at higher risk. Review the need for continued dual therapy at regular intervals.

Well established in clinical trials and guidelines. The combination is recommended in specific settings, but the increased bleeding risk is consistently documented.