New research presented at the American Heart Association’s Scientific Sessions 2025 suggests that two commonly used antiplatelet medications, ticagrelor and prasugrel, may not be interchangeable for patients with Type 1 or Type 2 diabetes who have received a drug-eluting stent. The TUXEDO-2 study, a randomized clinical trial involving 1,800 adults in India with diabetes and multivessel coronary disease, compared the effectiveness of these two P2Y12 inhibitors in preventing adverse cardiac events.
According to the study, the 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. Additionally, rates of non-fatal heart attack (5.96% vs. 5.21%), major bleeding (8.41% vs. 7.14%), and death (5.03% vs. 3.67%) were all numerically lower in the prasugrel group. Lead author Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine, noted, “We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel.”
Current guidelines from the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes recommend at least one year of dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) after drug-eluting stent implantation. However, the choice between ticagrelor and prasugrel has often been left to clinician preference. Dr. Bangalore emphasized, “For individuals with Type 1 or Type 2 diabetes and complex coronary disease, there may be an advantage to treatment with prasugrel over ticagrelor, and importantly, the two should not be used interchangeably.”
The study enrolled patients from 66 healthcare sites across India between 2020 and 2024, with an average age of 60 years; 71% were men. All participants had undergone percutaneous coronary intervention and received a drug-eluting stent. Approximately 79% had acute coronary artery syndrome, and 85% had triple vessel disease. The medication comparison portion followed patients for one year, while other parts of the TUXEDO trial will continue for five years.
Study limitations include the open-label design (patients and physicians knew the assigned medication), lack of compliance assessment, and the fact that the study was conducted solely in India, which may limit generalizability to other populations. The findings are considered preliminary until published in a peer-reviewed journal. The American Heart Association notes that abstracts presented at its scientific meetings are not peer-reviewed but are curated by independent panels.
Additional resources on dual antiplatelet therapy and diabetes are available from the American Heart Association’s Target: Type 2 Diabetes initiative and its health information on aspirin and dual antiplatelet therapy.
