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Prasugrel vs. Ticagrelor: Can TUXEDO-2 Settle the Debate?
Riccardo Prezzavento1, Davide Capodanno1
1A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Cardiology Unit, Italy, Italy, Catania.
Thrombosis and Haemostasis
|June 24, 2026
Summary
Prasugrel and ticagrelor are potent P2Y12 inhibitors for acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI). New data challenge the assumption that these drugs are interchangeable, favoring prasugrel in selected patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Prasugrel and ticagrelor are superior P2Y12 inhibitors compared to clopidogrel for ACS patients undergoing PCI.
- Both agents have a Class I recommendation, but clinical interchangeability remains debated due to limited head-to-head data.
Purpose of the Study:
- To evaluate the optimal choice between prasugrel and ticagrelor in ACS patients undergoing PCI.
- To challenge the assumption of clinical interchangeability between prasugrel and ticagrelor.
Main Methods:
- Analysis of recent large randomized trials, including ISAR-REACT 5 and TUXEDO-2.
- Review of pharmacological and clinical evidence comparing prasugrel and ticagrelor.
Main Results:
- Convergent findings from recent trials consistently favor one agent over the other.
- Accumulated evidence supports a specific therapeutic preference based on mechanistic and clinical data.
Conclusions:
- The assumption of clinical interchangeability between prasugrel and ticagrelor is challenged by new evidence.
- A case is built for the preferential use of prasugrel in appropriately selected ACS patients undergoing PCI.
- Therapeutic inertia against prasugrel is no longer scientifically justifiable.
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