byAmerican Heart Association

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One year of dual antiplatelet therapy with one of two potent P2Y12 inhibitors—ticagrelor or prasugrel—in people with Type 1 or Type 2 diabetes who had received a drug-eluting stent did not offer the same level of benefit at preventing stent clotting, heart attacks and bleeding complications, according to a preliminary late-breaking science presentation today at the American Heart Association'sScientific Sessions 2025. The meeting, held Nov. 7–10 in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

The TUXEDO-2 study is arandomized clinical trialevaluatingpercutaneous coronary interventionstrategies, including stent choice, revascularization approach, and antiplatelet therapy, in 1,800 adults in India with Type 1 or Type 2 diabetes and multivessel disease. All of the patients enrolled in the study had one of two specificdrug-eluting stentsimplanted after a percutaneous coronary intervention to clear a blockage. Stents are implanted to increaseblood flowin a narrowed or blocked vessel, and drug-eluting stents are coated with a medication to help reduce the risk of re-narrowing of the stents.

This part of the study specifically focused on comparing two antiplatelet medications, prasugrel and ticagrelor, which were prescribed to the patients, along with aspirin, after the stent procedure. Researchers reviewed the rate of stroke, heart attack, bleeding complications or death after one year of the medication regimens.

"Our findings indicate that prasugrel may potentially be the better choice for patients with Type 1 or Type 2 diabetes," said lead study author Sripal Bangalore, M.D., M.H.A., FAHA, a professor of medicine at NYU Grossman School of Medicine in New York City. "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."

The study found:

"Currently, these medications are treated as interchangeable. However, our findings provide evidence that they might be a bit different," Bangalore said. "For individuals with Type 1 or Type 2 diabetes and complex coronary disease, there may be an advantage to treatment with prasugrel over ticagrelor, and importantly, the two should not be used interchangeably."

Dual antiplatelet therapy, which includes aspirin plus a P2Y12 inhibitor agent, preventsblood clotsand reduces the risk of adverse cardiac events in people withacute coronary syndrome. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromesrecommendsat least one year of dual antiplatelet therapy for all patients after implantation of a drug-eluting stent.

Study details, background and design:

Study limitations included that patients and physicians knew to which medication the patients were assigned. In addition, compliance with the assigned treatment wasn't assessed, meaning that there was no way to be certain study participants took all medications exactly as prescribed. In addition, the study was done only in India, therefore findings may not apply to countries with different health systems or populations.

Provided by American Heart Association