Prasugrel vs Ticagrelor vs Clopidogrel: Which Performs Best After PCI?<\/p>\n
Prasugrel Shows the Best Efficacy\u2013Safety Balance After PCI<\/p>\n
P2Y\u2081\u2082 Inhibitors After PCI \u2014
\nMeta-analysis<\/p>\n
\u2022\u2060 \u2060Study: Systematic review and meta-analysis of 15 RCTs ; 48,904 patients; 93.9% ACS; mean follow-up 12.1 months.
\n\u2022\u2060 \u2060Compared prasugrel, ticagrelor, and clopidogrel after PCI.
\n\u2022\u2060 \u2060Prasugrel vs clopidogrel: \u2193 MACE 20%, \u2193 MI 29%, \u2193 stent thrombosis 52%.
\n\u2022\u2060 \u2060Prasugrel vs ticagrelor: \u2193 MACE 17%, \u2193 MI 22%, \u2193 stent thrombosis 34%.
\n\u2022\u2060 \u2060Ticagrelor vs clopidogrel: no significant reduction in MACE or MI; \u2193 stent thrombosis 27%.
\n\u2022\u2060 \u2060Major bleeding: higher with ticagrelor vs clopidogrel (OR 1.24); no significant difference between prasugrel and clopidogrel.
\n\u2022\u2060 \u2060Intracranial hemorrhage: higher with ticagrelor vs clopidogrel (OR 1.89).
\n\u2022\u2060 \u2060Drug discontinuation due to adverse events: higher with ticagrelor vs clopidogrel (OR 2.07).
\n\u2022\u2060 \u2060No significant differences in all-cause mortality, CV mortality, or ischemic stroke among the three agents.
\n\u2022\u2060 \u2060Overall: Prasugrel ranked best for MACE, MI, and stent thrombosis, providing the most favorable overall efficacy\u2013safety balance.
\n\u2022\u2060 \u2060Clinical context: Consistent with the 2023 ESC ACS guideline preference for prasugrel over ticagrelor in appropriate patients with ACS undergoing PCI.<\/p>\n
Source: PACE-CME | August 18, 2026 \u2014 based on a JAMA Cardiology<\/p>\n