From Ticagrelor to Prasugrel․ ISAR-REACT 5 Findings Redefine Clinical Practice
Davide Capodanno, Professor of Cardiology at University of Catania, editor-in-Chief of EuroIntervention, shared on X:
”A shift from ticagrelor to prasugrel occurred in Denmark following the findings of the ISAR-REACT 5 trial and the updated ESC guideline recommendation favoring prasugrel.
In 2019, more than 99% of patients received ticagrelor; by 2022, 89% received prasugrel. This study is truly exceptional in its scope: among 10,984 patients with myocardial infarction undergoing PCI, prasugrel was associated with lower rates of MACE and recurrent myocardial infarction after statistical adjustment, with similar bleeding rates compared with ticagrelor.
These results were replicated in a propensity score–matched cohort, in patients aged ≥75 years, and in those with non-STEMI.
Considering the TUXEDO-2 data presented at AHA25 and soon to be published, and with the inevitable meta-analysis that will strengthen the case for prasugrel, this nationwide study adds further evidence that the two ‘more potent P2Y12 inhibitors’ are, after all, not as equivalent as often assumed.”
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