Ticagrelor vs. prasugrel – which is more effective as a maintenance treatment after a heart attack?

This study compared ticagrelor (Brilique) and prasugrel (Efient) as a maintenance antiplatelet therapy (APT) after a myocardial infarction (MI; heart attack). They found that ticagrelor had a better APT effect and fewer bleeding events.

Coronary artery disease (CAD) is a condition that leads to reduced blood flow to the heart muscle. CAD is caused by blockages in blood vessels of the heart. This increases the risk of myocardial infarction (MI). If a blockage is detected patients may undergo a surgical procedure to remove it. This is called percutaneous coronary intervention (PCI). Medication can also be used to prevent more blockages. Platelets are a type of blood cell. They can cluster together and cause a blockage after procedures like PCI. 

Ticagrelor and prasugrel are drugs that prevent platelets cluster. They are prescribed to reduce the risk of MI or other events like stroke. This is called antiplatelet therapy (APT). However, APT can be associated with a higher risk of bleeding events. Endothelial cells (ECs) also play a role in platelet function and blood clotting. Improving EC function may be important in reducing the risk of MI. It is unclear if ticagrelor or prasugrel is more effective as APT after an ST-segment MI (STEMI; a type of heart attack). 

This study included 110 patients with STEMI. Patients were randomly assigned to either ticagrelor or prasugrel treatment. APT effectiveness and EC function were measured. Major adverse cardiac events (MACE) such as MI, stroke or death due to CAD and bleeding events were the main outcome. The follow-up period of this study was 1.5 years. 

APT effectiveness was higher in patients treated with ticagrelor (91%) at 1-year follow-up. This was compared to 82% in the prasugrel group. EC function was also improved in patients treated with ticagrelor. No improvement was seen in EC function in the prasugrel group.

The rate of MACE was similar in both groups (10% for ticagrelor vs 14% for prasugrel). Bleeding events slightly fewer in the ticagrelor group (47%) compared to the prasugrel group (63%). 

The authors concluded that ticagrelor had a better APT effect and fewer bleeding events compared to prasugrel in patients who had a STEMI. 

The number of patients in this study is low. This makes it difficult to compare the drugs. Larger studies are needed. The long-term effects on these outcomes are still unclear. 

If you have any concerns regarding CAD management please discuss this with your doctor.