Brilinta vs Plavix: what's the difference?

Effectiveness of Brilinta vs Plavix

Brilinta (ticagrelor) and Plavix (clopidogrel) are used to prevent blood clots in patients with heart issues to reduce risk of having a stroke, serious heart problems, or death.

Using PLATO clinical trial figures Brilinta appeared to work better than clopidogrel as Brilinta had 1.9% less deaths in the first year of treatment from CV issues , MI or stroke.

The PLATO clinical trial studied Brilinta + aspirin compared to clopidogrel + aspirin, was sponsored by AstraZeneca who makes Brilinta. The percentage of patients that had cardiovascular (CV) death, myocardial infarction (MI) or stroke in the first year of treatment was:

• Ticagrelor + aspirin = 9.8%
• Cloidogrel + aspirin =11.7%
• The difference between two groups is 11.7% - 9.8% =1.9 %
• Ticagrelor had 1.9% less deaths from CV, MI and stroke compared to clopidogrel.

The CURE clinical trial studied Plavix + aspirin compared to placebo + aspirin. The percentage of CV death, MI or stroke in the first year of treatment was

• Plavix + aspirin = 9.3%
• placebo + aspirin = 11.4%

In the CURE study Plavix + aspirin had a lower rate of CV death, MI or stroke in the first year of treatment.

Boxed warnings of Brilinta vs Plavix

Both have boxed warnings, but for different issues.

Plavix boxed warning is for

• "CYP2C19 poor metabolizers" as their bodies are unable to convert Plavix into the active form, so that it has a limited effect in these people.

Brilinta has two boxed warnings

• bleeding risk
• doses of aspirin above 100 mg daily reduce effectiveness of Brilinta therefore should be avoided.

Side Effects of Brilinta vs Plavix

Like all medications they both have side effects, the most commonly discussed side effect is bleeding for both medicines, due to their effects on reducing blood clotting. There are a number of different studies measuring the bleeding side effect, but the different studies have different severity of bleeding categories and different ways of measuring this side effect. This makes it hard to compare which one has more bleeding side effects.

Brilinta patients have a higher level of breathing difficulties (dyspnea) when compared to Plavix.

For more information on other side effects click on

• Brilinta side effects
• Plavix side effects

Dosing of Brilinta vs Plavix

Plavix is a once a day tablet compared to Brilinta which is a twice a day tablet.

Table comparing Brilinta and Plavix

	Brilinta (ticagrelor)	Plavix (clopidogrel)
Indication	Acute coronary syndrome or a history of myocardial infarction. Coronary artery disease but no prior stroke or myocardial infarction. Reduce the risk of stroke in patients with an acute ischemic stroke or high-risk transient ischemic attack	Acute coronary syndrome. Recent MI, recent stroke, or established peripheral arterial disease.
Boxed warning	Yes: Bleeding risk, reduced effect with aspirin dose above 100mg day	Yes: Reduced effect on patients who are "CYP2C19 poor metabolizers"
FDA approval date	20 July 2011	17 November 1997
Generic availability	No	Yes
Action	Reversibly interact with the platelet P2Y12 ADP-receptor	Irreversible binding to the P2Y12 class of ADP receptors on platelets.
Form	60mg oral tablet 90mg oral tablet	75mg oral tablet 300mg oral tablet
Frequency	Twice daily	Once daily
Dosage	Acute coronary syndrome or a history of myocardial infarction: 180mg loading dose then 90mg twice daily for one year, then reduce to 60mg twice daily Coronary artery disease but no prior stroke or myocardial or infarction: 60 mg twice daily. Reduce the risk of stroke in patients with an acute ischemic stroke or high-risk transient ischemic attack: 180mg loading dose then 90mg twice a day for up to 30 days	Acute Coronary Syndrome: loading dose 300mg then 75mg once daily Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75mg daily - no loading dose required
Antidote	No	No
Most commonly reported side effects	Bleeding 11.6 %, breathing difficulties 15-21%	Bleeding 11.2%
Interactions	Simvastatin, lovastatin, digoxin, opioids, aspirin, strong CYP3A inducers, strong CYP3A Inhibitors	CYP2C19 inhibitors, omeprazole or esomeprazole, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (CYP2C9 Substrates), SSRIs and SNRIs, repaglinide (CYP2C8 substrates)
Effectiveness: (Number of patients who had a cardiovascular death, MI or stroke in first year)	Ticagrelor + aspirin = 9.8% (PLATO study)	Plavix + aspirin =11.7% (PLATO study) Plavix +aspirin = 9.3% (CURE study)

Bottom Line:

• Brilinta (ticagrelor) appears to be slightly more effective than Plavix (clopidogrel) in reducing the percentage of CV death, MI or stroke in the first year of treatment
• Brilinta patients had more breathing difficulties as a side effect compared to Plavix patients.
• Brilinta has a blackbox warning for severity of bleeding risk and also for reduced effect with aspirin dose above 100mg day.
• Plavix has a black box warning for patients who are "CYP2C19 poor metabolizers” as Plavix will have reduced effect on these patients.

Related questions

• Is ticagrelor better than clopidogrel?
• How long does Plavix stay in the body once I stop taking it. How much Plavix is too much?
• How long do I have to take Brilinta after a stent or heart attack?