A preliminary study presented today at the American Heart Association's Scientific Sessions 2025 in New Orleans indicates that the two potent P2Y12 inhibitors, ticagrelor and prasugrel, may not be interchangeable for patients with Type 1 or Type 2 diabetes who have received a drug-eluting stent. The TUXEDO-2 study, a randomized clinical trial involving 1,800 adults in India, found that prasugrel was associated with numerically lower rates of the composite outcome of heart attack, stroke, bleeding complications, or death after one year compared to ticagrelor.
The study, led by Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine, specifically focused on patients with diabetes and multivessel coronary disease who underwent percutaneous coronary intervention with stent implantation. All patients were prescribed either ticagrelor or prasugrel along with aspirin as part of dual antiplatelet therapy. The primary composite outcome occurred in 14.23% of the prasugrel group versus 16.57% in the ticagrelor group. Rates of non-fatal heart attack, major bleeding, and death were also lower in the prasugrel group.
Dr. Bangalore noted that the results were unexpected, as they hypothesized ticagrelor would be at least as effective as prasugrel. “Our findings indicate that prasugrel may potentially be the better choice for patients with Type 1 or Type 2 diabetes,” he said. The study challenges the current practice of treating these medications as interchangeable, suggesting that prasugrel might offer advantages for this specific patient population.
The TUXEDO-2 study was conducted at 66 healthcare sites across India from 2020 to 2024. Participants had an average age of 60 years, with 71% men and 29% women. About 79% had acute coronary syndrome, and 85% had triple vessel disease. The study assessed outcomes after one year of medication, with follow-up continuing for five years for other trial endpoints. Limitations include the open-label design and the fact that the study was conducted only in India, which may affect generalizability to other populations.
These findings are considered preliminary until published in a peer-reviewed journal. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes recommends at least one year of dual antiplatelet therapy after drug-eluting stent implantation. This study adds nuance to the choice of P2Y12 inhibitor, particularly for patients with diabetes. More information on dual antiplatelet therapy can be found on the American Heart Association website.
