Relative efficacy and safety of ticagelor vs clopidogrel as a function of time to invasive management in non–ST‐segment elevation acute coronary syndrome in the PLATO trial

Background Guidelines suggest that “upstream” P2Y12 receptor antagonists should be considered in patients with non–ST‐segment elevation acute coronary syndromes (NSTE‐ACS). Hypothesis Early use of ticagrelor in patients managed with an invasive strategy would be more effective than clopidogrel because of its more rapid onset of action and greater potency. Methods In the PLATO trial, 6792 NSTE‐ACS patients were randomized to ticagrelor or clopidogrel (started prior to angiography) and underwent angiography within 72 hours of randomization. We compared efficacy and safety outcomes of ticagrelor vs clopidogrel as a function of “early” (