In patients with diabetes and multivessel coronary artery disease undergoing PCI, a ticagrelor-based dual antiplatelet therapy (DAPT) regimen did not offer the same level of benefit at preventing heart attack, stroke, bleeding complications or death as a prasugrel-based DAPT regimen, based on findings from the TUXEDO-2 trial presented at AHA 2025.

Conducted at 66 health centers in India, the trial included 1,800 adults (median age of 60 years/29% women) who had Type 1 or Type 2 diabetes and multivessel disease. All had undergone PCI with a drug-eluting stent. Researchers noted that roughly 25% of study participants were taking insulin, 79% had acute coronary artery syndrome, and 85% had triple vessel disease.

Overall results showed the composite rate of heart attack, stroke, bleeding complications or death was numerically lower in the prasugrel group compared with the ticagrelor group (14.23% vs. 16.57%, respectively). Broken down by outcome, the rate of nonfatal heart attack was 5.96% in the ticagrelor group compared with 5.21% in the prasugrel group; the rate of major bleeding was 8.41% among those taking ticagrelor vs. 7.14% among those taking prasugrel; and the rate of death 5.03% in the ticagrelor group and 3.67% in the prasugrel group.

“Our findings indicate that prasugrel may potentially be the better choice for patients with Type 1 or Type 2 diabetes,” said Sripal Bangalore, MD, MHA, FACC, the lead study author. “We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel. It’s important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable.”


Clinical Topics:
Acute Coronary Syndromes, Anticoagulation Management, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and ACS, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging


Keywords:
AHA Annual Scientific Sessions, AHA25, Acute Coronary Syndrome, Angiography, Anticoagulants, Metabolic Syndrome