The use of prasugrel in patients undergoing PCI is addressed in Section 5. Ticagrelor Ticagrelor is an oral, reversibly binding P2Y12 inhibitor with a relatively short plasma half-life (12 hours). Compared with clopidogrel, ticagrelor has a more rapid and consistent onset of action and, because it is reversible, it has a faster recovery of platelet function. The loading dose of ticagrelor for patients treated either invasively or with an ischemia-guided strategy is 180 mg followed by a maintenance dose of 90 mg twice In patients with NSTE-ACS treated with ticagrelor compared with clopidogrel, there was a reduction in the com- posite outcome of death from vascular causes, MI, or stroke The mor- tality rate was also lower in those patients treated with ticagre- lor. Although overall major bleeding was not increased with ticagrelor, a modest increase in major bleeding and non pro- cedure-related bleeding occurred in the subgroup of patients who did not undergo CABG (major bleeding: 4.5% versus 2.3%; P=0.05); however, there was no difference in blood transfusion or fatal bleeding.305 Side effects unique to ticagre- lor include dyspnea (which occurs in up to 15% of patients within the first week of treatment but is rarely severe enough to cause discontinuation of treatment)293 and bradycardia. The benefit of ticagrelor over clopidogrel was limited to patients taking 75 mg to 100 mg of aspirin.290 The short half-life requires twice-daily administration, which could potentially result in adverse events in non-compliant patients, particularly after stent implantation. When possible, ticagrelor should be discontinued at least 5 days before surgery.306 Although ticagrelor has not been studied in the absence of aspirin, its use in aspirin-intolerant patients is a reasonable alternative. Intravenous GP IIb/IIIa Receptor Inhibitors The small molecule GP IIb/IIIa receptor antagonists, tirofiban and eptifibatide, bind reversibly to the GP IIb/IIIa receptor. 