Background-Ticagrelor is the first reversibly binding oral P2Y 12 receptor antagonist. This is the first study to compare the onset and offset of platelet inhibition (IPA) with ticagrelor using the PLATO (PLATelet inhibition and patient Outcomes) trial loading dose (180 mg ) with a high loading dose (600 mg) of clopidogrel. Methods and Results-In a multicenter, randomized, double-blind study, 123 patients with stable coronary artery disease who were taking aspirin therapy (75 to 100 mg/d)

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... ed ticagrelor (180-mg load, 90-mg BID maintenance dose [nϭ57]), clopidogrel (600-mg load, 75-mg/d maintenance dose [nϭ54]), or placebo (nϭ12) for 6 weeks. Greater IPA (20 mol/L ADP, final extent) occurred with ticagrelor than with clopidogrel at 0.5, 1, 2, 4, 8, and 24 hours after loading and at 6 weeks (PϽ0.0001 for all); by 2 hours after loading, a greater proportion of patients achieved Ͼ50% IPA (98% versus 31%, PϽ0.0001) and Ͼ70% IPA (90% versus 16%, PϽ0.0001) in the ticagrelor group than in the clopidogrel group, respectively. A faster offset occurred with ticagrelor than with clopidogrel (4-to-72-hour slope [% IPA/h] Ϫ1.04 versus Ϫ0.48, PϽ0.0001). At 24 hours after the last dose, mean IPA was 58% for ticagrelor versus 52% for clopidogrel (PϭNS). IPA for ticagrelor on day 3 after the last dose was comparable to clopidogrel at day 5; IPA on day 5 for ticagrelor was similar to clopidogrel on day 7 and did not differ from placebo (PϭNS). Conclusions-Ticagrelor achieved more rapid and greater platelet inhibition than high-loading-dose clopidogrel; this was sustained during the maintenance phase and was faster in offset after drug discontinuation.