Acetylsalicylic acid × Ticagrelor

Aspirin irreversibly blocks platelet cyclooxygenase and ticagrelor reversibly blocks the P2Y12 receptor, so their antiplatelet effects add up. This is standard dual antiplatelet therapy after an acute coronary syndrome, and the ticagrelor label pairs it with a low daily dose of aspirin. The risk depends on the aspirin dose. In an exploratory analysis of the PLATO trial, ticagrelor's advantage over clopidogrel shrank as the aspirin dose rose. The Spanish label (AEMPS) therefore does not recommend maintenance aspirin doses above 300 mg, and the US label (FDA) advises keeping daily aspirin at 100 mg or less.

Bleeding risk adds up: bruising, gum bleeding, nosebleeds, black stools, blood in urine. Ticagrelor dyspnoea appears in the first weeks and does not by itself require stopping. High aspirin doses also add gastric discomfort.

Aspirin stays at a low dose, usually 75–100 mg daily (FDA label, ESC guidelines), and is not raised to analgesic regimens while ticagrelor lasts. For pain or fever use paracetamol rather than raising the aspirin dose or adding another NSAID. Dual antiplatelet therapy is not interrupted on personal initiative.