Prasugrel outperforms ticagrelor in routine care of acute coronary syndrome

Study design: This cohort study emulated a randomized trial using data from a German health insurance claims database (2012-2021). It included 17,642 propensity score-matched patients with acute coronary syndrome (ACS) undergoing invasive treatment. Patients were followed for one year after receiving either ticagrelor or prasugrel.

Results: Prasugrel was associated with a significantly lower incidence of the primary composite endpoint of all-cause mortality, MI, or stroke compared with ticagrelor (7.5% vs. 9.2%; hazard ratio [HR], 1.24; 95% CI, 1.12-1.37). MI (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) were more frequent in the ticagrelor group. No significant between-group differences were observed in all-cause mortality, stent thrombosis, or major bleeding.

Impact on clinical practice: Prasugrel may be preferred over ticagrelor for ACS patients undergoing invasive treatment, particularly for reducing risk of MI and stroke. Overall, the findings supports guideline recommendations favoring prasugrel over ticagrelor in this patient population.

Source:

Kruger N, et al. (2024, December 2). JAMA Netw Open. Ticagrelor vs Prasugrel for Acute Coronary Syndrome in Routine Care. https://pubmed.ncbi.nlm.nih.gov/39621344/