P2Y12 inhibitors in Staphylococcus aureus bacteraemia: current evidence and clinical implications

Staphylococcus aureus bacteraemia presents a substantial clinical burden, with high rates of morbidity and mortality. Despite its severity, therapeutic advancements have been small in the past decade, prompting exploration of adjunctive treatment strategies against S aureus bacteraemia. Among these strategies, P2Y12 inhibitors have gained attention due to their potential antistaphylococcal and platelet-modulating effects. Preclinical studies suggest that ticagrelor enhances platelet-mediated bacterial killing and interferes with S aureus metabolism. Clinical data indicate a potential protective effect of ticagrelor in S aureus bacteraemia, as compared with that of clopidogrel. Nevertheless, clopidogrel itself appears to offer protective effects, when compared with no treatment. However, these findings are based exclusively on non-randomised studies conducted in individuals with cardiovascular disease. Two randomised trials currently in development could provide further evidence on the therapeutic role of P2Y12 inhibitors in S aureus bacteraemia. Future research should also focus on preventive strategies and identifying populations at high risk who could benefit from such interventions.