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Monica Amin, PharmD
Monica Amin joined the Marley Drug team in 2022, prior to which she held various roles in the pharmaceutical industry as a pharmacist. Monica holds a PharmD and is actively pursuing an MBA.
Oct 2, 2025

Antiplatelets

Ticagrelor vs. Prasugrel for Heart Patients

  • Both ticagrelor and prasugrel are powerful antiplatelet medications used to prevent dangerous blood clots in people with heart conditions.
  • They are often prescribed after a heart attack or stent placement to reduce the risk of future cardiovascular events like another heart attack or stroke.
  • While both medicines effectively prevent clots, they differ in how often they are taken and in some specific warnings and considerations for use.
  • The most significant safety concern for both drugs is an increased risk of bleeding, so it's crucial to follow your doctor's instructions carefully.

Ticagrelor (brand name: Brilinta) and Prasugrel (brand name: Effient) are prescription medications that help prevent blood clots. They are mainly used in people who have had a heart attack, angina, or a stent placed in their heart.

These drugs belong to a group called antiplatelets. Platelets are tiny blood cells that help stop bleeding by clumping together. But in people with heart disease, platelets can clump too much and form dangerous clots that block blood flow to the heart or brain.

Ticagrelor and Prasugrel work by blocking signals that tell platelets to stick together. This lowers the chance of clots forming inside blood vessels, which helps reduce the risk of another heart attack or stroke.

Ticagrelor vs. Prasugrel: What They're For

Prasugrel (Effient) Ticagrelor (Brilinta)
Used For: People with acute coronary syndrome (ACS) who are undergoing a procedure called PCI (percutaneous coronary intervention). Used For: People who have had
  • Heart attack
  • ACS
  • Coronary artery disease (CAD)
  • Minor stroke/TIA
How It Works: Changes how platelets work to stop them from clumping together and forming clots, especially after a stent is placed. How It Works: Makes platelets less likely to stick together, helping prevent clots from forming in blood vessels.
Used After: A stent procedure to keep the artery open and prevent new clots from forming. Used After: A heart attack, stent placement, or minor stroke to lower the risk of another event.
Conditions Treated:
  • Unstable angina (chest pain at rest)
  • NSTEMI (partial blockage heart attack)
  • STEMI (full blockage heart attack)
 Conditions Treated:
  • ACS (heart attack or unstable angina)
  • CAD in high-risk patients (e.g., with diabetes)
  • Minor stroke or TIA (mini-stroke)
Should be taken with low-dose aspirin. Both work together to prevent clots. Can be taken with low-dose aspirin.

How They're Taken

Prasugrel (Effient) Ticagrelor (Brilinta)
Form/Strengths: Tablet/ 5 mg, 10 mg Form/Strengths: Tablet/ 60 mg, 90 mg
How Often: Once a day How Often: Twice a day
Can be taken with or without food. Taking it with a meal may help if it causes stomach discomfort. Can be taken with or without food. Taking it with food may help reduce nausea.
Must be swallowed whole. Can be crushed, mixed with water if you have trouble swallowing tablets. Be sure to drink all the liquid and rinse the cup to get the full dose.
Missed Dose: Take your next dose at the usual time. Do not double up. Missed Dose: Take your next dose at the usual time. Do not double up.

Important: These medications must be taken exactly as prescribed. Skipping doses or stopping them without medical advice can increase your risk of serious complications like heart attack or stroke. Always talk to your healthcare provider before making any changes.

Prasugrel (Effient) Ticagrelor (Brilinta)
Common Side Effects:
  • Easy bruising
  • Nosebleeds
  • Headache
  • Dizziness or nausea
  • High blood pressure
  • Fatigue
  • Back pain
 Common Side Effects:
  • Easy bruising
  • Nosebleeds
  • Headache
  • Dizziness
  • Shortness of breath
  • Nausea
Serious Risks:
  • Bleeding in the brain or stomach
  • Higher risk in people who are:
    • Age 75 or older
    • Under 132 lbs (60 kg)
    • Have kidney problems
    • Taking NSAIDs or blood thinners
    • Recently had surgery, trauma, or ulcers
 Serious Risks:
  • Bleeding in the stomach, intestines, or brain
  • May require blood transfusion or surgery
Do Not Take If You:
  • Have active bleeding
  • Have had a stroke or mini-stroke (TIA)
  • Are allergic to prasugrel or its ingredients
 Do Not Take If You:
  • Are currently bleeding (e.g., ulcer or injury)
  • Have had bleeding in the brain
  • Are allergic to ticagrelor or its ingredients
Call Your Doctor If You Notice:
  • Slurred speech or sudden weakness
  • Blurry vision or severe headache
  • Bleeding that won’t stop
  • Vomiting blood or coffee-ground-like vomit
  • Pink or brown urine
  • Black or red stools
  • Unexplained or growing bruises
  • Coughing up blood or clots
 Call Your Doctor If You Notice:
  • Bleeding that won’t stop
  • Pink, red, or brown urine
  • Vomiting blood or coffee-ground-like vomit
  • Black or red stools
  • Coughing up blood or clots
Before Surgery: May need to stop 7 days before surgery. Before Surgery: May need to stop 5 days before surgery. Do not stop without medical advice.
Important Reminder: Never stop taking prasugrel without talking to your provider. Stopping too soon after a stent can lead to a heart attack or death. Important Reminder: Do not stop ticagrelor suddenly, especially if you have a stent. It can raise your risk of a heart attack or clot. Also, avoid aspirin doses over 100 mg unless directed.

Safety Profile

Both ticagrelor and prasugrel can increase your risk of bleeding. This is the most common and serious concern with these medications. While many patients experience no major issues, some side effects may require immediate medical attention.

Talk to Your Doctor

Choosing between ticagrelor and prasugrel depends on several factors, including your age, medical history, past procedures, and risk of bleeding.

These medications work in similar ways but are not always used for the same cases. Some patients may benefit more from one over the other, while others may face a higher risk of side effects depending on other medications they take or health conditions they have.

Before starting or stopping either medication, speak with your doctor. Let your doctor know about any side effects, recent injuries, or if you have surgery planned, as this can affect how your medication is managed.

Understanding how these medications work and how they fit into your overall treatment plan can help reduce confusion and support better outcomes.