Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Comparative Effectiveness and Safety of Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome: A Retrospective Cohort Analysis

“…The findings from our study regarding the lower risk of recurrent CVD and major bleeding events are somewhat different than the results of the PRAGUE‐18 study, observational studies, and meta‐analyses of randomized clinical trials (RCTs) . The PRAGUE‐18 study was a multicenter RCT that was terminated prematurely because no significant difference was found in the primary end point (composite of death, reinfarction, urgent target vessel revascularization, stroke, or serious bleeding requiring transfusion or prolonging hospitalization at 7 days) between ticagrelor and prasugrel (odds ratio 0.98, 95% CI 0.55–1.73) .…”

“…The trial, however, suffered from several limitations including use of a broad composite outcome measure that included components that may not be affected by antiplatelet agents (e.g., prolonged hospitalization not associated with CVD or bleeding events), an open‐label design, being underpowered, and the differential loss of follow‐up between the ticagrelor and prasugrel groups. Similarly, two other studies reported similar effectiveness comparing ticagrelor and prasugrel . The study that used the French database had several limitations including a lack of balance in baseline characteristics after matching as illustrated in the large standardized differences across all pairwise comparisons in the study …”

Ticagrelor versus prasugrel for secondary prevention after percutaneous coronary intervention: A systematic review and meta-analysis

“…We also found that prasugrel use is associated with a significantly lower risk of bleeding at long term, which contrasts with findings from the previous meta-analysis, and those of the ISAR-REACT 5 trial, which showed no difference in the risk of bleeding between the two drugs at one year. 7,8 This finding is especially interesting given that prasugrel actually showed an increased risk of bleeding compared to clopidogrel in its landmark trial, while ticagrelor did not show this finding under similar conditions. 7 However, for unclear reasons, head-to-head comparisons of prasugrel and ticagrelor have shown either a reduced risk of bleeding with prasugrel or no difference between the two groups.…”

“…5, 6 Previously, meta-analysis of observational studies has demonstrated the superiority of prasugrel over ticagrelor in reducing short and long-term mortality; however, pooled results from randomised controlled trials (RCTs) have shown no difference between the two agents. 7 Since the previous analysis, three new RCTs and 10 observational studies have emerged. Most notable among these is the recent ISAR-REACT 5 trial, 8 which favoured prasugrel over ticagrelor in a composite outcome of death, myocardial infarction (MI) and stroke.…”

Antiplatelet Therapy after Coronary Artery Bypass Graft Surgery, Inconsistency of Clinical Practice and Clinical Significance of Proven Resistance to Antiplatelet Agents

“…The TRITON-TIMI 38 trial comparing prasugrel with clopidogrel in patients with moderate to high risk ACS (ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina) who underwent PCI demonstrated improved clinical outcomes with prasugrel as compared to clopidogrel [20]. A systematic review and recent meta-analysis suggest that prasugrel might have a better efficacy profile than ticagrelor in patients with ACS undergoing PCI, but this advantage was only seen in pooled observational studies and is likely to be affected by selection bias [21]. The latest trial comparing ticagrelor with prasugrel randomized 4018 patients which presented with ACS with or without ST-segment elevation (in whom invasive evaluation was planned), and the incidence of death, MI, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups [22].…”