Prasugrel versus ticagrelor in Indian patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective, randomized, comparative study

Abstract

Objective: This prospective, open-label, randomized study compared the efficacy and safety of prasugrel and ticagrelor in the Indian patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Materials and methods: Patients were randomized to prasugrel (n = 50; 60mg loading dose, thereafter 10mg once daily [OD]) or ticagrelor (n = 50; 180mg loading dose, thereafter 90mg twice daily [BD]) for 12 months. Patients received aspirin 325mg loading and 150mg maintenance doses OD with prasugrel and 150mg bolus and 75mg OD with ticagrelor. Efficacy end points were reinfarction/repeat angina/repeat ischemia, death from cardiovascular causes, ischemic stroke, and stent thrombosis. Safety end points included bleeding, arrhythmias, and dyspnea. Results: At 12 months, the occurrence of composite efficacy end points was not significantly different between the groups (6.4% for both; P = 0.999). The incidence of stent thrombosis, reinfarction/recurrent angina/repeat ischemia was comparable between the groups. No significant difference was observed for major bleeding (0% for both groups) and minor bleeding (10.6% vs. 4.3%; P = 0.436) episodes between the groups. Similarly, bradycardia (6.5% vs. 0%; P = 0.242) and dyspnea (10.6% vs. 2.1%; P = 0.204) were not significantly different between the groups. No deaths were reported. Conclusion: Head-to-head comparison of prasugrel and ticagrelor in the Indian patients with ACS undergoing PCI showed that both are equally efficacious. Clinical safety and tolerance of the patients were comparable between prasugrel and ticagrelor groups at the end of 1 year.