Sub Lingual Versus Traditional Oral Administration of Ticagrelor in Acute Coronary Syndrome/Non ST-elevation Myocardial Infarction - A Platelet Reactivity Study

Inclusion criteria

• Patients presenting with ACS/NSTEMI
• Informed, written consent

Exclusion criteria

• Age < 18 years or Age > 90 years
• Active bleeding; bleeding diathesis; coagulopathy
• Increased risk of bradycardiac events
• History of gastrointestinal or genitourinary bleeding <2 months
• Major surgery in the last 6 weeks
• History of intracranial bleeding or structural abnormalities
• Suspected aortic dissection
• Any other condition that may put the patient at risk or influence study results or investigator's opinion (severe hemodynamic instability, known malignancies or other comorbid conditions with life expectancy <1 year)
• Administration in the week before the index event of clopidogrel, ticlopidine, prasugrel, ticagrelor, thrombolytics, bivalirudin, low-molecular weight heparin or fondaparinux.
• Concomitant oral or IV therapy with strong CYP3A inhibitors or strong CYP3A inducers, CYP3A with narrow therapeutic windows
• Known relevant hematological deviations: Hb <10 g/dl, PLT<100x10^9/l
• Use of coumadin derivatives within the last 7 days
• Chronic therapy with ticagrelor, prasugrel, clopidogrel or ticlopidine
• Known severe liver disease, severe renal failure
• Known allergy to the study medications
• Pregnancy
• Human immunodeficiency virus treatment