Coronary disease & ACSMeta-analysis
Efficacy and Safety of Prasugrel, Ticagrelor, or Clopidogrel After Percutaneous Coronary Intervention
- Systematic review and network meta-analysis of randomised trials
- mixed treatment comparison
- random-effects
Authors' conclusion
In this systematic review and meta-analysis of 15 randomized clinical trials in patients who underwent PCI, prasugrel provided the optimal balance between efficacy and safety compared with ticagrelor and clopidogrel.
Study context
- Population
- Patients who underwent percutaneous coronary intervention (PCI)
- Participants
- 48,904 patients · 15 RCTs
- Comparison
- Prasugrel and ticagrelor vs clopidogrel after PCI
- Outcome
- Efficacy: MACE; safety: major bleeding
Pooled result
As reported in the abstract
MACE
Odds ratio (95% CI)
Prasugrel vs Clopidogrel
0.80(0.69–0.93)
Prasugrel vs Ticagrelor
0.83(0.70–0.98)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| MI — Prasugrel vs Clopidogrel | 0.71 (0.62–0.82) | |
| MI — Prasugrel vs Ticagrelor | 0.78 (0.65–0.94) | |
| Stent thrombosis — Prasugrel vs Clopidogrel | 0.48 (0.37–0.62) | |
| Stent thrombosis — Ticagrelor vs Clopidogrel | 0.73 (0.59–0.91) | |
| Stent thrombosis — Prasugrel vs Ticagrelor | 0.66 (0.49–0.88) | |
| 0.20.5125Odds ratio (log scale) |
Ranking for major adverse cardiovascular events (MACE), MI and stent thrombosis
- Prasugrel ranked first, followed by ticagrelor and clopidogrel
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Major bleeding (primary safety outcome) | 1.24 (1.01–1.52) | |
| Intracranial hemorrhage | 1.89 (1.08–3.33) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Efficacy and Safety of Prasugrel, Ticagrelor, or Clopidogrel After Percutaneous Coronary Intervention. JAMA Cardiol. Published 1 July 2026. doi:10.1001/jamacardio.2026.1128
Summarised from the published abstract; every number is checked against it