Key result
Low-dose prasugrel showed no statistically significant difference in major adverse cardiovascular events compared to clopidogrel (RR 0.73), but ranked highest for both efficacy and safety in the network meta-analysis.
Why the study?
Low-dose prasugrel could offer a better balance between ischemic and bleeding events than other P2Y12 inhibitors in DAPT for ischemic heart disease, but its comparative risks required evaluation.
Does low-dose prasugrel improve major adverse cardiovascular events and bleeding outcomes compared to other P2Y12 receptor inhibitors in patients with ischemic heart disease?
Meta-Analysis (n=53,216)
Does low-dose prasugrel improve major adverse cardiovascular events and bleeding outcomes compared to other P2Y12 receptor inhibitors in patients with ischemic heart disease?
Relative Risk: 0.73 (95% CI 0.49–1.09)
Low-dose prasugrel may provide an optimal balance of ischemic efficacy and bleeding safety compared to standard-dose prasugrel, ticagrelor, and clopidogrel in patients with ischemic heart disease.
May balance ischemic and bleeding risks with low-dose prasugrel; extends RCT network evidence for P2Y12 selection in ischemic heart disease.
Low-dose prasugrel could provide a better balance between adverse ischemic and bleeding events compared to other P2Y12 receptor inhibitors as part of dual antiplatelet therapy (DAPT) for patients with ischemic heart disease. This study evaluated these risks of adverse events associated with low-dose prasugrel and other P2Y12 receptor inhibitors. A network meta-analysis was conducted, searching for randomized controlled trials (RCTs) comparing clopidogrel (75 mg), low-dose (3.75 mg) and standard-dose (10 mg or 5 mg) prasugrel, or ticagrelor (180 mg). The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. The secondary endpoint was major bleeding, cardiovascular death, myocardial infarction, and stroke. Across 13 RCTs, neither low-dose prasugrel, standard-dose prasugrel, nor ticagrelor showed a statistically significant difference in MACE compared to clopidogrel [risk ratio (RR): 0.73, 95% confidence interval (CI) 0.49-1.09; RR: 0.86, 95% CI 0.68-1.09; RR: 1.02, 95% CI 0.62-1.67, respectively]. However, the standard dose of prasugrel was associated with a significantly higher risk of bleeding events compared to clopidogrel (RR, 0.72; 95% CI 0.35-1.49; RR, 1.26; 95% CI 1.01-1.58; RR, 1.26; 95% CI 0.82-1.96). The surface under the cumulative ranking curves was highest for low-dose prasugrel for both MACE and bleeding events (17.3 and 64.6 for clopidogrel, 84.5 and 84.9 for low-dose prasugrel, 62.0 and 11.8 for standard-dose prasugrel, and 36.2 and 38.7 for ticagrelor, respectively). Low-dose prasugrel may be a viable option in addition to standard P2Y12 receptor inhibitors.
No takes yet. Share an insight, caveat, or question.
Fujii et al. (2025) conducted a meta-analysis in Ischemic heart disease (n=53,216). Low-dose prasugrel vs. Clopidogrel (75 mg) was evaluated on Major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke (RR 0.73, 95% CI 0.49-1.09). Low-dose prasugrel showed no statistically significant difference in major adverse cardiovascular events compared to clopidogrel (RR 0.73), but ranked highest for both efficacy and safety in the network meta-analysis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: