Prasugrel vs Ticagrelor vs Clopidogrel: Which Performs Best After PCI?
Prasugrel vs Ticagrelor vs Clopidogrel: Which Performs Best After PCI?
Prasugrel Shows the Best Efficacy–Safety Balance After PCI
P2Y₁₂ Inhibitors After PCI —
Meta-analysis
• Study: Systematic review and meta-analysis of 15 RCTs ; 48,904 patients; 93.9% ACS; mean follow-up 12.1 months.
• Compared prasugrel, ticagrelor, and clopidogrel after PCI.
• Prasugrel vs clopidogrel: ↓ MACE 20%, ↓ MI 29%, ↓ stent thrombosis 52%.
• Prasugrel vs ticagrelor: ↓ MACE 17%, ↓ MI 22%, ↓ stent thrombosis 34%.
• Ticagrelor vs clopidogrel: no significant reduction in MACE or MI; ↓ stent thrombosis 27%.
• Major bleeding: higher with ticagrelor vs clopidogrel (OR 1.24); no significant difference between prasugrel and clopidogrel.
• Intracranial hemorrhage: higher with ticagrelor vs clopidogrel (OR 1.89).
• Drug discontinuation due to adverse events: higher with ticagrelor vs clopidogrel (OR 2.07).
• No significant differences in all-cause mortality, CV mortality, or ischemic stroke among the three agents.
• Overall: Prasugrel ranked best for MACE, MI, and stent thrombosis, providing the most favorable overall efficacy–safety balance.
• Clinical context: Consistent with the 2023 ESC ACS guideline preference for prasugrel over ticagrelor in appropriate patients with ACS undergoing PCI.
Source: PACE-CME | August 18, 2026 — based on a JAMA Cardiology
https://pace-cme.org/news/network-meta-analysis-compares-p2y12-inhibitors-after-pci/2488125/