Study Finds Different Outcomes for Anti-Clotting Medications in Diabetic Patients After Stent Placement

The effectiveness of two commonly used anti-clotting medications varied significantly in patients with Type 1 or Type 2 diabetes who had undergone stent placement, according to preliminary research presented at the American Heart Association's Scientific Sessions 2025. The TUXEDO-2 study, a randomized clinical trial conducted at 66 healthcare sites across India, found that while both prasugrel and ticagrelor are P2Y12 inhibitors prescribed to prevent blood clot formation, they did not offer the same level of benefits in preventing stent clotting, heart attacks, and bleeding complications.

The study involved 1,800 adults with an average age of 60 years, 71% men and 29% women, all with Type 1 or Type 2 diabetes and multivessel coronary disease. All participants had undergone percutaneous coronary intervention with drug-eluting stent implantation and were prescribed dual antiplatelet therapy consisting of aspirin plus either prasugrel or ticagrelor. The research team followed patients for one year to assess outcomes, with other parts of the TUXEDO trial continuing for five years.

Study results revealed significant differences between the two medication groups. The primary composite outcome of heart attack, stroke, bleeding complications or death occurred at a rate of 16.57% in the ticagrelor group compared to 14.23% in the prasugrel group. More specifically, the rate of non-fatal heart attack was 5.96% with ticagrelor versus 5.21% with prasugrel, while major bleeding occurred in 8.41% of ticagrelor patients compared to 7.14% of prasugrel patients. Mortality rates also differed, with 5.03% of ticagrelor patients dying compared to 3.67% in the prasugrel group.

Lead study author Sripal Bangalore, M.D., M.H.A., FAHA, a professor of medicine at NYU Grossman School of Medicine in New York City, expressed surprise at the findings. "We hypothesized that ticagrelor should be as good or perhaps even better than prasugrel," Bangalore said. "Our findings indicate that prasugrel may potentially be the better choice for patients with Type 1 or Type 2 diabetes. 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 American Heart Association notes that dual antiplatelet therapy, which includes aspirin plus a P2Y12 inhibitor, prevents blood clots and reduces the risk of adverse cardiac events in people with acute coronary syndrome. Current guidelines recommend at least one year of dual antiplatelet therapy for all patients after implantation of a drug-eluting stent.

Study limitations included that both patients and physicians knew which medication patients were assigned to receive, and compliance with the assigned treatment wasn't assessed. Additionally, since the study was conducted only in India, the findings may not apply to countries with different health systems or populations. The research abstract is available through the American Heart Association Scientific Sessions 2025 Online Program Planner, though the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.