Background Ticagrelor is oral antagonist of adenosine diphosphate receptors of subtype P2Y12. It is indicated for the prevention of atherothrombotic events in adults with acute coronary syndromes (ACS) and it act faster and shorter than clopidogrel.

Objectives The authors review and discuss clinical findings and health-economic evidence of ticagrelor compared with clopidogrel to reduced myocardial infarction, stroke or death, major bleeding, in patients with ACS in Colombia, when only one RCT has been published comparing both drugs.

Methods This question was part of the guideline development. The process included search, assessment, rating the quality of evidence and economic evaluation. The recommendations were classified according to the methodology described by GRADE Working Group: consideration benefit/harm, preferences and resources.

Results 1 clinical study was identified. The efficacy outcome was favourable for the group of patients receiving ticagrelor. The result of the economic analysis suggests that the probability of ticagrelor is a cost effective alternative in the Colombian health system is more than 76.6%.

Discussion We recommend ticagrelor plus ASA for patients with non-STEMI, intermediate to high-risk, and for patients with STEMI if they have not received fibrinolysis in the last 24 hours.

Implications for Guideline Developers/Users Our results hold in different scenarios and sensitivity analyses, as long as the time horizon is not limited to short-term assessment because may underestimate the costs and benefits and therefore lead to erroneous conclusions with a single primarily study. Our recommendation is strong, although there was a single RCT owing to time horizon and high quality of evidence.