Prasugrel diminished main cardiovascular occasions to the identical extent as ticagrelor however with decrease main bleeding after coronary stenting in sufferers with acute coronary syndromes, in line with outcomes from the SWITCH SWEDEHEART trial introduced in a Scorching Line session at present at ESC Congress 2026 and revealed concurrently within the New England Journal of Medication.
A potent P2Y12 inhibitor plus aspirin is the usual of care to stop main cardiovascular occasions in sufferers with acute coronary syndromes (ACS) who’ve undergone percutaneous coronary intervention (PCI).
The relative deserves of two potent P2Y12 inhibitors – prasugrel and ticagrelor – have been broadly debated, famous Principal Investigator of SWITCH SWEDEHEART, Professor Elmir Omerovic from Sahlgrenska College Hospital, Gothenburg, Sweden: “Within the ISAR-REACT 5 trial, a prasugrel-based technique was superior to a ticagrelor-based technique for main cardiovascular occasions with out a rise in main bleeding, however whether or not the identical distinction can be seen in an unselected inhabitants in on a regular basis medical observe was unknown,” he defined, persevering with, “A number of Swedish healthcare areas determined to undertake prasugrel because the default P2Y12 inhibitor for ACS and we used this transformation as the premise for a practical analysis of a default prasugrel coverage in contrast with ticagrelor utilizing the established SWEDEHEART registry platform.” The 2023 ESC Tips already state that prasugrel must be thought of instead of ticagrelor for ACS sufferers who bear PCI (class IIa, Degree B). SWITCH SWEDEHEART provides pragmatic, registry-based randomized proof in an unselected inhabitants.
The registry-based SWITCH SWEDEHEART trial randomized areas relatively than particular person sufferers: seven Swedish areas in three clusters switched their default P2Y12 inhibitor from ticagrelor to prasugrel at staggered, randomly assigned instances (a stepped-wedge design).
The trial included all 17,095 consecutive adults with ACS present process PCI, together with aged sufferers and people with prior stroke or a sign for oral anticoagulation, who’re often excluded from trials. Underneath the ticagrelor coverage, 9,444 sufferers had been advisable to obtain ticagrelor 90 mg twice each day. Underneath the prasugrel coverage, 7,651 sufferers had been advisable to obtain prasugrel 10 mg as soon as each day diminished to five mg as soon as each day in sufferers aged 75 years or older, or weighing lower than 60 kg, as per the label.
The first endpoint of dying from any trigger, myocardial infarction or stroke at one 12 months occurred in related proportions of sufferers with every therapy coverage: 11.1% of sufferers below the prasugrel coverage and 11.8% below the ticagrelor coverage (adjusted odds ratio [OR] 0.90; 95% confidence interval [CI] 0.77 to 1.06). The person elements of the first endpoint didn’t differ.
Of word, the chance of main bleeding at one 12 months was considerably decrease with the prasugrel coverage in contrast with the ticagrelor coverage (4.2% vs. 4.4%; OR 0.80; 95% CI 0.64 to 0.99).
Commenting on the primary of SWITCH SWEDEHEART’s essential conclusions, Professor Omerovic mentioned: “Within the largest randomized comparability so far, prasugrel supplied comparable safety towards main cardiovascular occasions, however with a sign towards much less bleeding and decrease price – a doubtlessly essential consideration for sufferers and healthcare methods.” Secondly, he famous the success of the novel methodology: “We had been capable of run a big policy-level, randomised trial inside a nationwide registry at a fraction of the price of a traditional trial, evaluating the affect of two remedies and an essential healthcare change in real-world sufferers. Our trial represents a mannequin of medical proof technology that might be used to nice impact throughout cardiology and in lots of different areas of healthcare.“
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