Prasugrel Compared With Ticagrelor in Patients With ACS Undergoing PCI

A systematic review and meta-analysis published in the American Journal of Cardiovascular Drugs compared the safety and efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

To investigate these newer P2Y₁₂ platelet inhibitors, the study authors conducted a literature search for randomized controlled trials (RCTs) and observational studies where patients with ACS undergoing PCI were treated with either prasugrel or ticagrelor. “Random-effects pooling was used to calculate odds ratios (ORs) with 95% confidence intervals (CI),” the authors explained.

Fourteen studies involving 40,188 patients were identified and included in the analysis (6 RCTs, 8 observational studies). “Pooled analysis did not indicate that prasugrel significantly decreased all-cause mortality compared with ticagrelor in the short term (OR 0.49; 95% CI 0.20–1.20; P=.11) or long term (OR 0.74; 95% CI 0.48–1.15; P=.38),” the study authors reported. However, when looking at just the observation studies, prasugrel was associated with significantly lower long-term all-cause mortality (OR 0.63) and short-term stent thrombosis (OR 0.46) compared with ticagrelor.

With regard to other endpoints (nonfatal myocardial infarction, ischemic stroke, bleeding, repeat revascularization), no significant difference was noted between the prasugrel- and ticagrelor-treated groups.

The study authors concluded that while the findings may suggest increased benefit with prasugrel, the “advantage was only seen in pooled observational studies and is likely to be affected by selection bias.”

Prasugrel and ticagrelor are both FDA-approved to reduce the risk of thrombotic cardiovascular events (including stent thrombosis) in patients with ACS who are to managed with PCI.

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