The effectiveness of two commonly used anti-clotting medications varied significantly in patients with diabetes who underwent stent placement procedures, according to research presented at the American Heart Association's Scientific Sessions 2025. The TUXEDO-2 study found that prasugrel and ticagrelor, both P2Y12 inhibitors typically prescribed interchangeably, produced different outcomes in patients with Type 1 or Type 2 diabetes who received drug-eluting stents.
This research matters because it challenges current clinical practice where these medications are often used interchangeably. For the millions of diabetic patients worldwide who undergo stent procedures annually, the choice between these medications could significantly impact their risk of serious complications including heart attack, stroke, bleeding events, and death.
The study followed 1,800 adults in India with diabetes and multivessel coronary disease who had received drug-eluting stents after percutaneous coronary intervention. Patients were randomly assigned to receive either prasugrel or ticagrelor along with aspirin as part of dual antiplatelet therapy. After one year of treatment, researchers found notable differences in outcomes between the two medication groups.
The primary composite outcome of heart attack, stroke, bleeding complications or death occurred at a rate of 16.57% in the ticagrelor group compared to 14.23% in the prasugrel group. More specifically, the rate of non-fatal heart attack was 5.96% with ticagrelor versus 5.21% with prasugrel, while major bleeding occurred in 8.41% of ticagrelor patients compared to 7.14% of prasugrel patients. Mortality rates also differed, with 5.03% of ticagrelor patients and 3.67% of prasugrel patients dying during the study period.
Lead study author Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine, expressed surprise at the results. "We hypothesized that ticagrelor should be as good or perhaps even better than prasugrel," Bangalore said. "It's important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable."
The implications of these findings are substantial for clinical practice. Current guidelines, including the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes, recommend at least one year of dual antiplatelet therapy for all patients after drug-eluting stent implantation but do not specify preference between these medications. This study suggests that for diabetic patients with complex coronary disease, prasugrel may offer advantages over ticagrelor.
The study's limitations include that patients and physicians knew which medication was assigned, and compliance with treatment wasn't systematically assessed. Additionally, since the research was conducted exclusively in India, the findings may not directly apply to populations in other countries with different healthcare systems. The research is considered preliminary until published in a peer-reviewed journal, as abstracts presented at the American Heart Association's scientific meetings are not peer-reviewed.
For diabetic patients requiring stent procedures, these findings highlight the importance of medication selection in dual antiplatelet therapy. With diabetes affecting cardiovascular health and increasing complication risks, optimized medication choices could significantly impact patient outcomes and quality of life following coronary interventions.
