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

The effectiveness of two commonly used anti-clotting medications varied significantly in patients with diabetes who underwent stent placement, according to research presented at the American Heart Association's Scientific Sessions 2025. The TUXEDO-2 study found that prasugrel and ticagrelor, both P2Y12 inhibitors prescribed to prevent blood clots, did not offer the same level of protection against heart attacks, strokes, bleeding complications, or death in patients with Type 1 or Type 2 diabetes.

The randomized clinical trial involved 1,800 adults in India with diabetes and multivessel coronary disease who had received drug-eluting stents after percutaneous coronary intervention. All patients received dual antiplatelet therapy consisting of aspirin plus either ticagrelor or prasugrel. The study revealed that 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.

Lead study author Dr. Sripal Bangalore, a professor of medicine at NYU Grossman School of Medicine, expressed surprise at the results. "We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel," Bangalore said. "It's important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable."

The detailed findings showed the rate of non-fatal heart attack was 5.96% in the ticagrelor group versus 5.21% in the prasugrel group. 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% of prasugrel patients.

This research challenges 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. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes recommends at least one year of dual antiplatelet therapy for all patients after implantation of a drug-eluting stent.

The study's implications are significant for the approximately 537 million adults worldwide living with diabetes, who face higher risks of cardiovascular complications. Diabetes patients often require stent procedures and subsequent antiplatelet therapy to prevent life-threatening complications. The findings suggest that medication selection could meaningfully impact patient outcomes, potentially reducing heart attacks, strokes, bleeding events, and mortality.

Study limitations include that patients and physicians knew which medication patients were assigned, compliance with treatment wasn't assessed, and the research was conducted only in India, meaning findings may not apply to countries with different health systems or populations. The research is considered preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at American Heart Association scientific meetings are not peer-reviewed.

The TUXEDO-2 study was conducted at 66 healthcare sites across India from 2020 to 2024. Participants had an average age of 60 years, with 71% men and 29% women. About one quarter of study participants were taking insulin, roughly 79% had acute coronary artery syndrome, and approximately 85% had triple vessel disease. The medication comparison analysis followed patients for one year, while other parts of the TUXEDO trial will continue for five years.