A new study presented at the American Heart Association’s Scientific Sessions 2025 suggests that two commonly used antiplatelet medications, ticagrelor and prasugrel, may not be interchangeable for patients with Type 1 or Type 2 diabetes who have undergone stent placement. The research, part of the TUXEDO-2 trial, found that prasugrel was associated with numerically lower rates of major adverse cardiovascular events and bleeding complications compared to ticagrelor when used as part of dual antiplatelet therapy with aspirin.
The study included 1,800 adults in India with diabetes and multivessel coronary disease who received a drug-eluting stent after percutaneous coronary intervention. Patients were randomly assigned to receive either ticagrelor or prasugrel, in addition to aspirin, for one year. The primary composite outcome of heart attack, stroke, bleeding complications, or death occurred in 16.57% of the ticagrelor group versus 14.23% in the prasugrel group. Rates of non-fatal heart attack (5.96% vs. 5.21%), major bleeding (8.41% vs. 7.14%), and death (5.03% vs. 3.67%) were all numerically lower with prasugrel.
“We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel,” said lead author Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine. “It’s important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable.” The findings challenge current clinical practice where these medications are often used interchangeably. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes recommends at least one year of dual antiplatelet therapy after drug-eluting stent implantation, but does not specify a preference among P2Y12 inhibitors in diabetic patients.
The study has limitations, including its open-label design and conduct solely in India, which may affect generalizability. Additionally, medication compliance was not assessed. Nevertheless, the results provide important evidence that the choice of antiplatelet therapy may significantly impact outcomes in this high-risk population. The TUXEDO-2 trial continues to follow patients for five years to assess longer-term effects.
