aspirin + ticagrelor + clopidogrel

The combination of aspirin, ticagrelor, and clopidogrel refers to the antiplatelet agents evaluated in a retrospective clinical study conducted by the Second Affiliated Hospital, School of Medicine, Zhejiang University. The study specifically compared two dual antiplatelet therapy (DAPT) regimens—aspirin plus ticagrelor versus aspirin plus clopidogrel—in patients with acute myocardial infarction (AMI) to assess their impact on coronary microvascular dysfunction (CMD). Aspirin is a salicylate that irreversibly inhibits cyclooxygenase-1 (COX-1), thereby preventing the synthesis of thromboxane A2 and subsequent platelet aggregation. Ticagrelor and clopidogrel are both P2Y12 receptor antagonists that inhibit ADP-induced platelet activation; however, ticagrelor is a direct-acting, reversible inhibitor, while clopidogrel is a thienopyridine prodrug that requires metabolic activation to irreversibly bind the receptor. The research utilized the angiography-derived index of microcirculatory resistance (angio-IMR) as a novel tool to evaluate the protective effects of these antiplatelet strategies on the coronary microvasculature.