One year of treatment with the blood-thinning medications ticagrelor and prasugrel in people with type 1 or type 2 diabetes who had received a drug-eluting stent for coronary artery blockages did not provide equal benefits in preventing stent clotting, heart attacks, and bleeding complications. This was reported at the American Heart Association’s Scientific Sessions 2025 in New Orleans on November 10.
“Our results suggest that prasugrel may be the better choice for patients with type 1 or type 2 diabetes,” said Sripal Bangalore, MD, director of research at NYU Langone’s Cardiac Catheterization Laboratory and in the Department of Medicine’s Leon H. Charney Division of Cardiology at NYU Grossman School of Medicine. “The results were unexpected, as we initially hypothesized that ticagrelor would be equally effective, if not better, than prasugrel. These findings highlight the importance of selecting the right medication, as our data indicate that ticagrelor and prasugrel are not interchangeable.”
The TUXEDO-2 study is a randomized clinical trial that evaluated strategies for treating coronary artery disease among 1,800 adults in India with diabetes and multivessel disease. The trial included analysis of stent selection, revascularization techniques, antiplatelet therapy options, and other approaches. All participants underwent percutaneous coronary intervention using one of two specific drug-eluting stents designed to prevent arteries from narrowing again.
This segment of the study compared prasugrel and ticagrelor as antiplatelet therapies prescribed alongside aspirin after stent placement. Researchers assessed rates of stroke, heart attack, bleeding complications, and death after one year.
“These medications are often considered interchangeable, but our findings suggest important differences,” Dr. Bangalore said. “For individuals with type 1 or type 2 diabetes and complex coronary disease, prasugrel may offer distinct advantages over ticagrelor. This research highlights the need for a more personalized approach to treatment, as the two drugs should not be used interchangeably.”
Current guidelines recommend dual antiplatelet therapy—including aspirin plus a P2Y12 inhibitor—for at least one year following placement of a drug-eluting stent to help prevent blood clots and reduce serious cardiac events.
Study limitations included lack of blinding for patients and physicians regarding assigned medications—a factor that could introduce bias—and unmonitored adherence to medication regimens.
NYU Langone Heart has been recognized as No. 1 nationally for cardiology and heart surgery by U.S. News & World Report due to its outcomes in treating various heart conditions such as rhythm disorders and valve disease across multiple locations including New York City and Florida.
NYU Langone Health is known for high patient outcome standards across its health system through a focus on quality care—resulting in some of the nation’s lowest mortality rates—and has been ranked No. 1 by Vizient Inc. among academic medical centers nationwide for four consecutive years.
