Objective To compare the therapeutic efficiency of ticagrelor and clopidogrel in the patients with acute coronary syndrome(ACS). Methods Clinical data of 657 ACS patients who were treated with aspirin combined with ticagrelor or clopidogrel and monitored by thromboelastography(TEG) in our department from March 2014 to May 2015 were collected in this study. They were all followed up for 12 months after discharge for the recurrence of major adverse cardiovascular events(MACE). The efficiency of ticagrelor and clopidogrel was compared between the 2 groups, and the risk factors for recurrence of MACE were analyzed. ResultsThe ticagrelor group had significantly higher inhibitory rate in adenosine diphosphate(ADP) pathway(P＜0.001), but obviously lower drug resistance(ADP＜30%) than the clopidogrel group(P＜0.001). The Kaplan-Meier survival analysis showed the incidence of MACE was 11.74% and 9.82% respectively in the ticagrelor and clopidogrel groups(P＝0.574). Cox regression analysis suggested that the risk factors for MACE were heart rate(B＝0.040, RR＝1.041, 95%CI: 1.018-1.064, P＝0.000) and estimated glomerular filtration rate(eGFR, B＝-0.010, RR＝0.990, 95%CI: 0.981-1.000, P＝0.048). There was no fatal bleeding events in the ticagrelor group, and the risk factor of inactive bleeding events was eGFR(B＝-0.022, OR＝0.987, 95%CI: 0.985-0.998, P＝0.031). Conclusion The therapeutic effect of ticagrelor is not superior to clopidogrel, but the former leads lower rate of drug resistance. ACS patients with lower eGFR are prone to experiencing inactive bleeding events, and those with faster heart rate are more likely to have recurrence of MACE.