Which drug improves blood flow and reduces inflammation after stent insertion in patients with heart disease?

This study compared three drugs to see which was better at improving blood flow and reducing inflammation after patients with heart disease were given a stent. The results showed that prasugrel (Efient) improved patients’ blood flow more than clopidogrel (Plavix) or ticagrelor (Brilique).

Heart disease, including acute coronary syndrome (ACS), can lead to heart attacks due to a narrowing of blood vessels. One way to prevent this is to widen blood vessels using a stent. However, sometimes patients’ blood flow from the heart is still reduced due to blood clots. Blood clotting is caused by platelets and inflammation.

Anti-platelet drugs can be used to prevent clotting. Prasugrel, clopidogrel and ticagrelor are three anti-platelet drugs. It is unclear which drug is better at improving blood flow in patients with ACS that had a stent inserted.

91 patients with ACS received either clopidogrel (31 patients), prasugrel (27 patients) or ticagrelor (33 patients) before having a stent inserted. Patients’ blood flow, inflammation, and clotting were assessed 1 day and 28 days after the stent was inserted.

Prasugrel improved blood flow better than clopidogrel and ticagrelor after stent insertion. Before stent insertion, blood flow improved by 1.5% with clopidogrel, 1.9% with prasugrel and 0.8% with ticagrelor.  One day after stent insertion, blood flow was reduced by 3.8% with clopidogrel, 3.5% with ticagrelor and insignificantly by 0.7% by prasugrel. This effect was strongest when patients started taking the drugs before stent insertion.

IL-6 is a sign of inflammation in the body. Prasugrel significantly reduced IL-6 levels more than clopidogrel or ticagrelor. 1 day and 28 days after stent insertion, prasugrel was better at reducing blood clotting compared to clopidogrel and ticagrelor. 

The authors concluded that prasugrel was better at improving blood flow and reducing inflammation and clotting after stent insertion in patients with ACS. They also found that this effect was more significant when prasugrel was given before stent insertion.

This study was limited by its small size (91 patients), the majority of which were men (81 patients). This study lacked a placebo to compare to the test drugs. This study would benefit from looking at patients over a longer period of time.