Effect of Ticagrelor on Reducing the Risk of Gram-Positive Infections in Patients With Acute Coronary Syndrome

•Patients treated with dual antiplatelet therapy that includes ticagrelor have a 64% lower risk of gram-positive infection during the first year following hospitalization compared with patients treated with dual antiplatelet therapy treatment that includes clopidogrel.•This observed association is bolstered by the fact that gram-positive infection risk is comparable between ticagrelor and clopidogrel treated patients after discontinuation of dual antiplatelet therapy.•Treatment with ticagrelor was not associated with a reduced risk of gram-negative infections during the first year following acute coronary syndrome hospitalization, a finding compatible with previous in vitro studies. In light of recent studies describing the antibacterial properties of ticagrelor, the association between treatment with ticagrelor and subsequent risk for infection following acute coronary syndrome (ACS) is taking on increased importance. A single center, retrospective, matched cohort analysis was performed. All patients older than 30 years of age admitted between January 1, 2013 and November 1, 2019 for an ACS and discharged with dual antiplatelet therapy (DAPT) were included. The primary outcome was defined as hospital admissions due to infections likely caused by gram-positive bacteria up to 1 year following the ACS hospitalization. The base cohort included 3,909 patients. About 2,035 (52.1%) were treated with ticagrelor and 1,874 (47.9%) with clopidogrel. Patients treated with ticagrelor had a 64% lower risk of gram-positive infection during the first year following hospitalization after adjusting for demographic and co-morbidity factors compared with those treated with clopidogrel (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21 to 0.61; p