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Dual Antiplatelet Therapy with Prasugrel or Ticagrelor Versus Clopidogrel in Interventional Cardiology

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Abstract

For several years, clopidogrel plus aspirin has been the dual antiplatelet therapy (DAPT) of choice for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation. More recently, prasugrel and ticagrelor have demonstrated greater efficacy than clopidogrel. In TRITON-TIMI 38, the risk of TIMI major bleeding unrelated to coronary artery bypass graft (CABG) surgery was similar for prasugrel and clopidogrel after excluding subgroups with increased bleeding risk (previous stroke or transient ischemic event; age ≥75 years; weight <60 kg). In the PLATO trial, rates of TIMI major bleeding were similar for ticagrelor and clopidogrel, but ticagrelor was associated with a significantly higher rate of non-CABG-related TIMI major bleeding. Current evidence suggests that prasugrel or ticagrelor plus aspirin should be the DAPT of choice in patients with ACS undergoing PCI unless they are at particularly high risk of bleeding. No studies have yet compared prasugrel and ticagrelor in ACS patients, however prasugrel and ticagrelor have different side effect profiles, and the choice of agent should be made either as a default choice and/or on an individual patient basis. Ongoing trials in ACS patients will increase the evidence base for new P2Y12 receptor inhibitors and help to establish the most effective DAPT regimens.

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Acknowledgments

The authors would like to acknowledge the assistance of Sarah Whitfield, medical writer, and Springer Healthcare Ltd in the preparation of this manuscript, supported by a grant from Daiichi Sankyo Europe GmbH and Eli Lilly and Company. The authors are responsible for the final version of the review.

Conflicts of Interest

Peter Clemmensen has previously or currently been involved in research contracts, consulting, speakers bureau or received research and educational grants from:

  • Abbott, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Sanofi, Searle, and Servier.

  • Lene Holmvang has received speaker honoraria from AstraZeneca, Bayer AG, Daiichi-Sankyo Europe GmbH and Eli Lilly and Company, and consulting fees from AstraZeneca, Bristol-Myers Squibb and Eli Lilly and Company.

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  1. Department of Cardiology B, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Peter Clemmensen, Nadia Paarup Dridi & Lene Holmvang

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  1. Peter Clemmensen
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Correspondence to Peter Clemmensen.

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Clemmensen, P., Dridi, N.P. & Holmvang, L. Dual Antiplatelet Therapy with Prasugrel or Ticagrelor Versus Clopidogrel in Interventional Cardiology. Cardiovasc Drugs Ther 27, 239–245 (2013). https://doi.org/10.1007/s10557-013-6444-2

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