Study Finds Prasugrel May Offer Better Outcomes Than Ticagrelor for Diabetic Patients With Stents
New research presented at the American Heart Association's Scientific Sessions 2025 suggests prasugrel may be more effective than ticagrelor at preventing heart attacks, strokes, bleeding complications and death in diabetic patients who received coronary stents, challenging current interchangeable use of these antiplatelet medications.
Patients with Type 1 or Type 2 diabetes who undergo stent placement may experience different outcomes depending on which antiplatelet medication they receive, according to new research presented at the American Heart Association's Scientific Sessions 2025. The TUXEDO-2 study found that prasugrel may offer better protection against heart attacks, strokes, bleeding complications and death compared to ticagrelor, despite both medications being commonly used interchangeably in clinical practice.
The randomized clinical trial involved 1,800 adults in India with diabetes and multivessel coronary disease who had received drug-eluting stents after percutaneous coronary intervention. All participants received dual antiplatelet therapy consisting of aspirin plus either prasugrel or ticagrelor. After one year of treatment, researchers found significant differences in outcomes between the two medication groups. The primary composite outcome of heart attack, stroke, bleeding complications or death occurred at a rate of 16.57% in the ticagrelor group compared to 14.23% in the prasugrel group.
Lead study author Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine, expressed surprise at the results. "We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel," Bangalore said. "It's important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable."
The study revealed specific differences in individual outcomes between the two treatment groups. The rate of non-fatal heart attack was 5.96% in the ticagrelor group versus 5.21% in the prasugrel group. Major bleeding occurred in 8.41% of ticagrelor patients compared to 7.14% of prasugrel patients. Most notably, the mortality rate was 5.03% in the ticagrelor group and 3.67% in the prasugrel group.
These findings challenge current clinical practice where these medications are often considered equivalent options. The American Heart Association notes that dual antiplatelet therapy, which includes aspirin plus a P2Y12 inhibitor like prasugrel or ticagrelor, is standard treatment to prevent blood clots and reduce cardiac event risk in patients with acute coronary syndrome. Current guidelines recommend at least one year of dual antiplatelet therapy for all patients after drug-eluting stent implantation.
The study's implications are particularly significant given the high prevalence of cardiovascular disease among people with diabetes. Approximately 79% of study participants had acute coronary artery syndrome, and about 85% had triple vessel disease, indicating advanced coronary artery disease. About one quarter of participants were taking insulin, reflecting the complexity of managing diabetes alongside cardiovascular conditions.
However, researchers caution that the study has several limitations. Both patients and physicians knew which medication was being administered, potentially introducing bias. Compliance with the assigned treatment wasn't assessed, meaning researchers couldn't verify if participants took all medications as prescribed. Additionally, the study was conducted exclusively in India, so findings may not apply to countries with different health systems or population characteristics.
The research was presented as part of the American Heart Association's Scientific Sessions 2025, described as a premier global exchange of the latest scientific advancements in cardiovascular science. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at the association's scientific meetings are not peer-reviewed.
For individuals with Type 1 or Type 2 diabetes and complex coronary disease, these results suggest there may be an advantage to treatment with prasugrel over ticagrelor. As Bangalore concluded, "For individuals with Type 1 or Type 2 diabetes and complex coronary disease, there may be an advantage to treatment with prasugrel over ticagrelor, and importantly, the two should not be used interchangeably."