Effectiveness of anti-clotting meds after stent placement varied in people with diabetes

Research Highlights:

• Two P2Y12 inhibitors often used interchangeably, ticagrelor and prasugrel (antiplatelet medications prescribed to prevent the formation of blood clots), had different impacts on outcomes in patients with Type 1 or Type 2 diabetes who had undergone stent placement, a procedure done to keep an artery open, and free of clots or a blockage.
• While both medications help prevent platelets from clumping together and forming a clot in a stent, the study showed they may not offer the same level of benefits in the patients studied.
• The composite rate of heart attack, stroke, bleeding complications or death was numerically lower in the prasugrel group than the ticagrelor group, as were the rates of each outcome of non-fatal heart attack, stroke, bleeding conditions or death.
• Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 8:15 a.m. CT/9:15 a.m. ET, Monday, Nov. 10, 2025

NEW ORLEANS, Nov. 10, 2025 - One year of dual antiplatelet therapy with one of two potent P2Y12 inhibitors-ticagrelor or prasugrel-in people with Type 1 or Type 2 diabetes who had received a drug-eluting stent did not offer the same level of benefit at preventing stent clotting, heart attacks and bleeding complications, according to a preliminary late-breaking science presentation today at the American Heart Association's Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

The TUXEDO-2 study is a randomized clinical trial evaluating percutaneous coronary intervention strategies, including stent choice, revascularization approach, and antiplatelet therapy, in 1,800 adults in India with Type 1 or Type 2 diabetes and multivessel disease. All of the patients enrolled in the study had one of two specific drug-eluting stents implanted after a percutaneous coronary intervention to clear a blockage. Stents are implanted to increase blood flow in a narrowed or blocked vessel, and drug-eluting stents are coated with a medication to help reduce the risk of re-narrowing of the stents.

This part of the study specifically focused on comparing two antiplatelet medications, prasugrel and ticagrelor, which were prescribed to the patients, along with aspirin, after the stent procedure. Researchers reviewed the rate of stroke, heart attack, bleeding complications or death after one year of the medication regimens.

"Our findings indicate that prasugrel may potentially be the better choice for patients with Type 1 or Type 2 diabetes," said 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. "We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel. It's important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable."

The study found:

• The primary composite outcome of heart attack, stroke, bleeding complications or death occurred at a rate of 16.57% in the ticagrelor group and 14.23% in the prasugrel group.
• The rate of non-fatal heart attack was 5.96% in the ticagrelor group and 5.21% in the prasugrel group; the rate of major bleeding in the ticagrelor group was 8.41% and 7.14% in the prasugrel group. The rate of death in patients taking ticagrelor was 5.03% and 3.67% in the prasugrel group.

"Currently, these medications are treated as interchangeable. However, our findings provide evidence that they might be a bit different," Bangalore said. "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."

Dual antiplatelet therapy, which includes aspirin plus a P2Y12 inhibitor agent, 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.

Study details, background and design:

• The TUXEDO-2 study was conducted at 66 health care sites across India. Enrollment for the trial was from 2020 to 2024 and the study researchers assessed the outcomes of participants after they had been randomly assigned to receive one of two types of stents, as well as two different types of dual anti-platelet therapy.
• The study included 1,800 adults (average age of 60 years; 71% men and 29% women) with Type 1 or Type 2 diabetes and multivessel coronary disease.
• The patients had undergone percutaneous coronary intervention (to restore blood flow to the artery), and a drug-eluting stent had been implanted.
• About one quarter of the study participants were taking insulin; roughly 79% had acute coronary artery syndrome; and approximately 85% had triple vessel disease.
• The primary clinical trial is evaluating the safety and efficacy of percutaneous coronary intervention with two drug-eluting stents in patients with Type 1 or Type 2 diabetes and multivessel coronary disease. The objective of this analysis was a randomized comparison of ticagrelor versus prasugrel, in addition to aspirin, to assess potential impact on heart attack, stroke, major bleeding complications and death.
• The patients in the two medication groups were similar in terms of age, sex, ethnicity and heart health status.
• The medication comparison analysis in the trial followed these patients for a year, and other parts of the Tuxedo trial will continue for five years.

Study limitations included that patients and physicians knew to which medication the patients were assigned. In addition, compliance with the assigned treatment wasn't assessed, meaning that there was no way to be certain study participants took all medications exactly as prescribed. In addition, the study was done only in India, therefore findings may not apply to countries with different health systems or populations.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2025 Online Program Planner
• American Heart Association news release: ACC, AHA Issue New Acute Coronary Syndromes Guideline (February, 2025)
• American Heart Association health information: Aspirin and Dual Antiplatelet Therapy
• American Heart Association health initiative: Target: Type 2 Diabetes A Spotlight on Type 2 Diabetes℠ and Get With The Guidelines®
• About Scientific Sessions 2025
• For more news at AHA Scientific Sessions 2025, follow us on X @HeartNews,#AHA25

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