Comparative Efficacy and Safety of Ticagrelor and Prasugrel in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials

Acute coronary syndrome remains a prominent cause of morbidity and mortality worldwide despite advances in percutaneous coronary intervention and pharmaceuticals. As such, the discovery and implementation of novel and safe preventative measures like ticagrelor and prasugrel need to be studied and their safety profiles compared. For this purpose, we compiled 3 randomized controlled trials and 1 post hoc study from PubMed, Web of Science, and Cochrane Central after thorough screening, in this meta-analysis. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death, myocardial infarction, composite ischemic events, stent thrombosis, stroke, and bleeding events. Prasugrel and ticagrelor demonstrated similar efficacy and safety in patients with acute coronary syndrome undergoing percutaneous coronary intervention. These findings support an individualized approach to P2Y12 inhibitor selection based on patient characteristics, contraindications, tolerability, and adherence considerations rather than a preference for either agent.