R.E.B.E.L.EM - July 02, 2020 - By Salim Rezaie
Paper: Schupke S et al. Ticagrelor or Prasugrel in Patients With Acute Coronary Syndromes. NEJM 2019. PMID: 31475799
"Clinical Question: Does ticagrelor or prasugrel improve the composite of death, myocardial infarction, or stroke at one year after randomization in patients with ACS?
Author Conclusion: “Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups.”
Clinical Take Home Point: In this multicenter, international randomized clinical trial of adult patients with ACS undergoing PCI, prasugrel was superior to ticagrelor in the primary outcome. Additionally, a prasugrel-based strategy with deferred loading after knowledge of the coronary anatomy was superior to a ticagrelor-based strategy with routine pretreatment in patients with NSTEMI and UA. Finally, when evaluating the individual results from the composite primary outcome, the findings of this study were driven by reduction in MI, not in death or stroke."