Interactions between aspirin and P2Y12 receptor antagonists in ischaemic heart disease

A combination of aspirin 75 mg once daily (OD) and the P2Y12 inhibitor ticagrelor represents the current standard antiplatelet treatment for acute coronary syndromes (ACS). Prolonged therapy is indicated in patients at high risk of ischaemic events but low risk of bleeding, though varying aspirin dose and frequency of administration may modulate its actions and consistency of effect. Daily doses of aspirin <75 mg may exert significant effect and twice-daily (BD) administration may improve consistency, but these regimens have not been studied in those receiving ticagrelor. Aspirin potentiates certain pathways of inflammation that may hypothetically drive atherogenesis and be counteractive in atherothrombosis. This project characterised a novel regimen of very-low-dose BD aspirin, when given alone and in combination with ticagrelor, compared to standard regimens of aspirin and DAPT.