Ticagrelor vs. Twice-Daily Clopidogrel in STEMI: Insights from the TADCLOT Trial

Introduction

The first 30 days following primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) represent a critical window of vulnerability. During this period, patients are at the highest risk for major adverse cardiovascular events (MACE), most notably stent thrombosis and recurrent myocardial infarction. Ensuring potent and consistent platelet inhibition is paramount to improving clinical outcomes. While current guidelines generally favor potent P2Y12 inhibitors like ticagrelor or prasugrel over clopidogrel, the use of a double-dose or twice-daily clopidogrel regimen has been proposed as a potentially more accessible or cost-effective alternative, particularly in regions where clopidogrel resistance is prevalent or newer agents are less accessible. The TADCLOT trial sought to address this clinical uncertainty by directly comparing ticagrelor with a twice-daily clopidogrel regimen in a high-risk STEMI population.

Highlights