Ticagrelor has pleiotropic effects not seen with clopidogrel, including inhibition of erythrocyte adenosine uptake (Bonello, Laine et al. 2014) and, in a preclinical model, reduction of infarct size, an adenosine and COX2 dependent effect that is inhibited by high but not low dose aspirin (Nanhwan, Ling et al. 2014). Chronic, but not acute, ticagrelor treatment may upregulate COX2 expression (Nanhwan, Ling et al. 2014) and ticagrelor, but not clopidogrel, improves post-infarct remodeling (Ye, Birnbaum et al. 2015) and has an anticontractile effect on vascular smooth muscle cells when exposed to ADP which is inhibited by high dose, but not low dose, aspirin (Grzesk, Kozinski et al. 2013).