Prasugrel Gains Ground: New Data Shifts the Landscape of Dual Antiplatelet Therapy
For years, ticagrelor has been a mainstay in dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). But recent findings from the TUXEDO-2 trial are challenging that status quo, suggesting prasugrel may offer a more favorable risk-benefit profile, particularly for patients with diabetes and multivessel coronary artery disease. This isn’t just a tweak to treatment guidelines; it’s a potential paradigm shift with significant implications for cardiovascular care.
The TUXEDO-2 Trial: A Closer Look at the Data
Presented at the American Heart Association Scientific Sessions in November 2025, the TUXEDO-2 trial randomized 1,800 patients from India – a population often underrepresented in major cardiovascular studies – to either ticagrelor or prasugrel, alongside either a biodegradable or durable polymer stent. The study’s primary endpoint – a composite of death, nonfatal myocardial infarction, stroke, or major bleeding – occurred in a significantly higher percentage of the ticagrelor group (16.57%) compared to the prasugrel group (14.23%). While the difference didn’t quite reach statistical significance, the trend strongly favors prasugrel.
Diabetes Duration and Bleeding Risk: Key Subgroup Analyses
Digging deeper, the data revealed crucial nuances. Prasugrel demonstrated a clear advantage in patients with a shorter duration of diabetes (less than 5 years) and those deemed at high risk for bleeding. This suggests a more personalized approach to DAPT selection is warranted, moving beyond a one-size-fits-all strategy. The findings align with previous research, such as the ISAR-REACT 5 trial, which also indicated a higher risk of adverse cardiovascular events with ticagrelor in acute coronary syndrome patients undergoing PCI.
Biodegradable vs. Durable Stents: A Non-Inferiority Win
Beyond the antiplatelet therapy comparison, TUXEDO-2 also provided compelling evidence for the efficacy of biodegradable polymer stents. The ultrathin-strut sirolimus-eluting Supraflex Cruz stent demonstrated non-inferiority to the durable-polymer Xience stent in terms of target lesion failure. This is a significant step forward, as biodegradable stents theoretically eliminate the long-term risk of late stent thrombosis and potentially promote more natural vessel healing. Researchers plan to continue following patients for five years to assess the long-term benefits of this newer stent technology.
The Promise of Bioresorbable Scaffolds
The success of the Supraflex Cruz stent adds to the growing body of evidence supporting the use of bioresorbable scaffolds. While earlier generations of these devices faced challenges, advancements in stent design and polymer technology are yielding increasingly promising results. The potential to restore natural vessel function and avoid the long-term presence of a foreign body within the coronary artery is a compelling prospect for the future of PCI. Learn more about bioresorbable scaffolds here.
Implications for Clinical Practice and Future Research
The TUXEDO-2 trial underscores the importance of carefully considering individual patient characteristics when selecting DAPT. For patients with diabetes and multivessel CAD, prasugrel may be the preferred choice, especially those with a shorter diabetes duration or a higher bleeding risk. The non-inferiority of biodegradable stents opens the door for wider adoption of this technology, potentially reducing long-term complications. However, further research is needed to fully understand the long-term benefits and optimal patient selection criteria for both prasugrel and biodegradable stents.
The future of PCI is likely to be characterized by increasingly personalized treatment strategies, driven by robust clinical trial data and a deeper understanding of individual patient risk profiles. What are your predictions for the role of prasugrel and biodegradable stents in the evolving landscape of cardiovascular care? Share your thoughts in the comments below!
