Ticagrelor Versus Prasugrel in Diabetes and Multivessel Coronary Disease: Insights From the TUXEDO-2 Trial

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Siddharth Pravin Agrawal1, Anjaneyulu Dunde2, Panti Maniyar3

  • 1From the Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI.

Cardiology in Review
|March 20, 2026
PubMed

Insights

For diabetic patients with acute coronary syndromes and multivessel disease, prasugrel may offer superior net clinical outcomes compared to ticagrelor, particularly after percutaneous coronary intervention. This finding is based on recent trial data in this high-risk population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Patients with diabetes and multivessel coronary artery disease are a high-risk group for acute coronary syndromes (ACS).
  • Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard post-percutaneous coronary intervention (PCI).
  • Ticagrelor and prasugrel are potent P2Y12 inhibitors with debated comparative efficacy in diabetic populations.

Purpose of the Study:

  • To review antiplatelet therapy in ACS, focusing on diabetic patients with complex coronary anatomy.
  • To summarize pharmacologic differences and trial data for ticagrelor and prasugrel.
  • To examine the TUXEDO-2 trial findings in diabetic patients with multivessel disease undergoing PCI.

Main Methods:

  • Review of pivotal trials including Platelet Inhibition and Patient Outcomes, TRITON-TIMI 38, and ISAR-REACT 5.
  • Analysis of the TUXEDO-2 trial design and results.
  • Comparative assessment of ticagrelor and prasugrel in high-risk diabetic patients.

Main Results:

  • Ticagrelor did not meet noninferiority against prasugrel in the TUXEDO-2 trial for a composite of ischemic and bleeding outcomes.
  • Prior evidence suggests varying efficacy between ticagrelor and prasugrel.
  • Prasugrel may offer better net clinical outcomes in diabetic patients with multivessel disease undergoing PCI.

Conclusions:

  • Prasugrel may be a preferred P2Y12 inhibitor over ticagrelor for diabetic patients with multivessel disease and ACS undergoing PCI.
  • Clinical implications suggest a potential shift in treatment strategy for this high-risk subgroup.
  • Further research may clarify optimal antiplatelet selection in complex diabetic populations.

Keywords:
diabetes mellitusdual antiplatelet therapymultivessel coronary artery diseasepercutaneous coronary interventionprasugrelticagrelor

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