Prasugrel vs Ticagrelor for DAPT in Patients with ACS Undergoing PCI: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ahmad Al-Abdouh, Mahmoud Barbarawi, Waiel Abusnina, Mahmoud Amr, Di Zhao, Nazir Savji, Rani K. Hasan, Erin D. Michos

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Introduction: Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor added to aspirin is considered the standard of care for patients with acute coronary syndrome (ACS) undergoing percutaneous intervention (PCI). Prasugrel and ticagrelor are commonly used P2Y12 inhibitors, and a few head-to-head randomized control trials (RCTs) have been performed. We performed a systematic review and meta-analysis of these RCTs to compare the efficacy and adverse effects between these two agents when used in patients with ACS undergoing PCI. Methods: We searched PubMed/MEDLINE and Cochrane library for RCTs comparing prasugrel to ticagrelor in ACS. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, major bleeding, and all bleeding event. Estimates were calculated as random effects risk ratios (RRs) with 95% confidence intervals (CI). Results: Six trials with 6807 patients were included. There were no significant difference of MACE (RR 0.93; 95% CI [0.72–1.20]; p = 0.59; I2 = 26%), all-cause mortality (RR 0.92; 95% CI [0.73–1.17]; p = 0.51; I2 = 0%), cardiovascular mortality (RR 0.99; 95% CI [0.75–1.31]; p = 0.96; I2 = 0%), MI (RR 0.87; 95% CI [0.60–1.27]; p = 0.48; I2 = 27%), stent thrombosis (RR 0.64; 95% CI [0.39–1.04]; p = 0.07; I2 = 0%), major bleeding (RR 0.94; 95% CI [0.70–1.26]; p = 0.68; I2 = 6%), and all bleeding event (RR 0.92; 95% CI [0.77–1.09]; p = 0.32; I2 = 0%) for prasugrel compared with ticagrelor. Conclusion: There are no significant difference of MACE, all-cause mortality, cardiovascular mortality, MI, stent thrombosis, and bleeding between prasugrel and ticagrelor when added to aspirin among patients with ACS undergoing PCI.

Original languageEnglish (US)
Pages (from-to)1613-1618
Number of pages6
JournalCardiovascular Revascularization Medicine
Issue number12
StatePublished - Dec 2020


  • Clinical trial
  • Complete
  • Culprit
  • Infarct related artery
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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