Ticagrelor or Prasugrel in Acute Coronary Syndromes — The Winner Takes It All?

In October 2019, the New England Journal of Medicine published this paper by Hani Jneid, M.D. It is about the study conducted by Schüpke S, et al. The research follows an open-label multicenter trial that pioneered the comparison of Ticagrelor and Prasugrel as a treatment for sufferers of acute coronary syndromes.

The patients in question were due for invasive evaluation at the time.

The multicenter randomized trial involved the random assignment of either prasugrel or ticagrelor to 4018 patients set to receive an invasive evaluation. The main endpoint had been the composite of myocardial infarction, stroke, and death at one year. Bleeding was considered the secondary endpoint.

Among those with acute coronary syndromes, there was a significantly lower incidence of stroke, death, and myocardial infarction among patients who took prasugrel than those who took ticagrelor. Despite this, the incidence of bleeding was not noted to be significantly different between the trial groups.

There was a disparity in effect size with NSTEMI vs STEMI, as well as differences between the timing of intake. For these reasons, there is a need to conduct more studies to figure out the most effective treatment strategy.

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