Comparative Study of Clopidogrel vs Prasugrel in Patients Undergoing Elective Percutaneous Coronary Intervention (Pci)

Antiplatelet therapy is a cornerstone in managing patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic complications. Prasugrel and clopidogrel are two commonly used agents, but their comparative efficacy and safety remain a subject of ongoing research, particularly in elective PCI cases. Objective: This study aimed to compare the safety and efficacy of prasugrel and clopidogrel in patients undergoing elective PCI, focusing on clinical outcomes such as minor and major bleeding, stent thrombosis, and mortality. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Pakistan between January and July 2024. A total of 200 patients undergoing elective PCI were included in the study. Patients received either clopidogrel (300 mg or 600 mg) or prasugrel (60 mg) as part of their antiplatelet therapy. Clinical outcomes were assessed, including minor and major bleeding, thrombosis, and death. Statistical analyses were performed using Pearson correlations, chi-square tests, and regression analysis. SPSS software (version 25.0) was used for data analysis, with statistical significance set at p < 0.05. Results: Of the 200 patients, 48.5% were male, and 51.5% were female, with the majority aged between 61 and 70. Prasugrel (60 mg) was the most commonly used loading dose (35.5%). Minor bleeding events were significantly higher in the prasugrel group compared to the clopidogrel group (p = 0.05). However, no significant differences were observed in major bleeding, stent thrombosis, or mortality between the two groups. A positive correlation between minor bleeding and stent thrombosis was noted (p = 0.048), while regression analysis confirmed that prasugrel did not significantly increase the risk of major bleeding or death. Conclusion: Prasugrel was associated with a higher incidence of minor bleeding compared to clopidogrel, but both agents exhibited comparable safety profiles in terms of major bleeding, thrombosis, and mortality in patients undergoing elective PCI. The findings suggest that prasugrel can be considered a safe and effective alternative to clopidogrel in elective PCI, with careful patient selection to minimize bleeding risks.