Prasugrel after PCI outperforms other common antiplatelet drugs
Giving patients prasugrel after percutaneous coronary intervention (PCI) is associated with an “optimal balance for efficacy and safety” not seen with clopidogrel or ticagrelor, according to a new meta-analysis published in JAMA Cardiology.[1]
Clopidogrel, ticagrelor and prasugrel are all oral P2Y purinergic receptor 12 (P2Y12) inhibitors prescribed to patients to help prevent blood clots. Clopidogrel is sold by Bristol-Myers Squibb and Sanofi under the brand name Plavix, ticagrelor is sold by AstraZeneca under the brand name Brilinta, and prasugrel is sold by Eli Lilly and Daiichi Sankyo under the brand name Effient.
While 2025 guidelines from the American College of Cardiology and American Heart Association recommend prasugrel or ticagrelor after PCI, 2023 guidelines from the European Society of Cardiology recommend prasugrel. To learn more about the use of these drugs in PCI patients, researchers explored data from nearly 49,000 patients who participated in one of 15 randomized clinical trials.
Overall, prasugrel was associated with a significantly lower risk of a major adverse cardiovascular event (MACE) than clopidogrel or ticagrelor. Ticagrelor finished No. 2 among the three therapies, and clopidogrel finished last.
Prasugrel was also linked to a lower myocardial infarction (MI) rate than the other two drugs, with ticagrelor once again finishing No. 2 and clopidogrel finishing No. 3. And prasugrel and ticagrelor were both associated with a reduced risk of stent thrombosis compared to clopidogrel.
Researchers also noted that major bleeding events were more likely among patients given ticagrelor than those given clopidogrel. In fact, clopidogrel performed the best in terms of major bleeding events, intracranial hemorrhage and drug discontinuation due to adverse events.
There was no difference between the three therapies, however, when looking at all-cause mortality, stroke or cardiovascular mortality.
“Overall, in the network meta-analysis, prasugrel reduced MACE, MI, and stent thrombosis with no increase in major bleeding compared with clopidogrel,” wrote first author M. Haisum Maqsood, MD, MS, a researcher with the DeBakey Heart and Vascular Center in Houston, and colleagues. “Ticagrelor reduced stent thrombosis, but increased major bleeding, intracranial hemorrhage, and drug discontinuation due to adverse events compared with clopidogrel. Finally, prasugrel reduced MACE, MI, and stent thrombosis with no increase in major bleeding compared with ticagrelor. Thus, prasugrel provided the optimal balance between efficacy and safety.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.