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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Access Route and Clinical Outcomes After Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome
Rayyan Hemetsberger1, Gert Richardt2, Shqipdona Lahu3
1Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany.
Insights
The access site does not impact the comparative efficacy and safety of ticagrelor versus prasugrel in acute coronary syndrome (ACS) patients undergoing invasive treatment. This finding holds true regardless of radial or femoral access, offering clarity for treatment decisions.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The influence of vascular access site on the comparative efficacy and safety of ticagrelor and prasugrel in acute coronary syndrome (ACS) patients undergoing invasive treatment is not well-established.
- Understanding this relationship is crucial for optimizing treatment strategies and patient outcomes.
Purpose of the Study:
- To investigate whether the access site (radial vs. femoral) affects the comparative efficacy and safety of ticagrelor and prasugrel in patients with ACS undergoing an invasive treatment strategy.
- To analyze post-hoc data from the ISAR-REACT 5 trial to address this specific clinical question.
Main Methods:
- A post-hoc analysis of the ISAR-REACT 5 trial was conducted, including ACS patients randomized to ticagrelor or prasugrel.
- Patients underwent invasive treatment via either radial or femoral access.
- The primary efficacy endpoint was a composite of death, myocardial infarction, or stroke, and the safety endpoint was Bleeding Academic Research Consortium (BARC) 3 to 5 bleeding, assessed up to 12 months.
Main Results:
- No significant interaction was found between the access route and the assignment to ticagrelor or prasugrel for primary efficacy or safety endpoints (P for interaction ≥ 0.616).
- In the radial access group, no statistically significant differences in efficacy or safety endpoints were observed between ticagrelor and prasugrel.
- In the femoral access group, ticagrelor was associated with a higher frequency of the primary efficacy endpoint compared to prasugrel (10.3% vs. 7.3%, P=0.006), with no significant difference in safety endpoints.
Conclusions:
- The vascular access site does not influence the comparative efficacy and safety of ticagrelor and prasugrel in patients with ACS undergoing invasive treatment.
- These findings suggest that treatment decisions regarding ticagrelor and prasugrel in ACS patients should not be based on the chosen access site.
Background:
Whether the access site influences the comparative efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing invasive treatment strategy remains unstudied.
Methods:
This post-hoc analysis included ACS patients undergoing invasive treatment via radial or femoral access and randomized to either ticagrelor or prasugrel in the ISAR-REACT 5 trial. The primary efficacy endpoint was the composite of death, myocardial infarction (MI) or stroke, safety endpoint was BARC 3 to 5 bleeding. Outcomes were assessed out to 12 months after randomization.
Results:
Out of 4018 patients, 3984 underwent invasive treatment via radial or femoral access. 1479 had coronary angiography via radial access (ticagrelor, N = 748; prasugrel, N = 731) and 2505 via femoral access (ticagrelor, N = 1245; prasugrel, N = 1260). There was no interaction between access route and assignment to either ticagrelor or prasugrel regarding the primary efficacy or safety endpoints (P for interaction≥0.616). In the radial group, the primary efficacy endpoint (7.6% versus 5.8%, HR: 1.32 [0.88-1.97], P = 0.151) and the safety endpoint (4.3% versus 3.0%, HR: 1.36, [0.73-1.31], P = 0.300) were not statistically different in patients receiving either ticagrelor or prasugrel. In the femoral group, the primary efficacy endpoint occurred more frequently in patients assigned to ticagrelor as compared to prasugrel (10.3% versus 7.3%, HR: 1.44 [1.10-1.88], P = 0.006) without significant difference in terms of safety endpoint (6.4% versus 5.8%, HR: 1.14, [0.81-1.60], P = 0.470).
Conclusions:
In patients with ACS undergoing an invasive treatment strategy, the access route does not influence the comparative efficacy and safety of ticagrelor and prasugrel.
Clinical Trial Registration:
NCT01944800.
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