Aim To access the antithrombotic effect of Ticagrelor and Clopidogrel in diabetic coronary atherosclerotic heart disease and further illustrate the role of serum advanced glycation end products(AGE) in treatment. Methods 120 patients suffered from diabetic coronary atherosclerotic heart disease hospitalized for percutaneous coronary intervention(PCI) in the department of cardiology, affiliated hospital of Jiangsu university were recruited from October 2014 to February 2017. They were randomly divided into two groups. Each group was provided with Clopidogrel and Ticagrelor, respectively. To compare the effect of anti-platelet therapy, platelet aggregation rates were measured via flow cytometry before and after double anti-platelet therapy. And platelet inhibition rate induced by arachidonic acid (AA) and adenosine diphosphate (ADP) pathway was measured by thrombus elastography. The levels of serum advanced glycation endproducts (AGE) were measured by ELISA. After treatment of 6 months, the occurrence of bleeding events and ischemic events were followed up in the two groups. Results The platelet aggregation rate of Ticagrelor group was significantly 14.09% lower than that of the Clopidogrel group ((35.92±7.57)% vs (41.81±9.56)%,P<0.05), but the platelet inhibition rate induced by ADP pathway was significantly higher than that of Clopidogrel group (1.22 fold)((65.73±11.69)% vs(53.67± 8.75)%,P<0.05). There was no significant difference in the level of serum AGE before treatment and in platelet inhibition rate induced by AA pathway between the two groups (P>0.05). After treatment the level of serum AGE in Ticagrelor group was significantly lower than that in Clopidogrel group (18.71 ± 3.14) mg/L vs (25.71 ± 4.01) mg/L, P<0.05). Pearson correlation analysis revealed that serum AGE levels were positively correlated with platelet aggregation (r=0.87, P<0.001) and negatively correlated with platelet inhibition (r=－0.95, P<0.001). There was no significant difference in bleeding events occurrence between the two groups after 6 months of treatment. However, the appearance of ischemic events in the Ticagrelor group was significantly lower than that in the Clopidogrel group (8.33% vs 18.33%, P<0.05). Conclusion Compared with Clopidogrel, Ticagrelor can significantly reduce platelet aggregation within one week after PCI and incidence of ischemic events within six months after PCI, and serum AGE may be the key node of this process.