Comparative evaluation of anti-inflammatory and antioxidant effects of prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention: A prospective cohort study

BACKGROUND: While both clopidogrel and prasugrel inhibit platelet aggregation, their comparative pleiotropic effects on inflammatory and oxidative stress markers remain unclear. OBJECTIVE: To compare the anti-inflammatory and antioxidant potential of clopidogrel and prasugrel given as dual antiplatelet therapy (DAPT) along with aspirin in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: In this prospective cohort study, patients aged 18–65 years undergoing PCI for ACS and eligible candidates for DAPT were included. The two study groups were: aspirin + clopidogrel (AC group; n = 52) and aspirin + prasugrel (AP group; n = 52). A change in inflammatory (high-sensitivity C-reactive protein [hs-CRP]) and oxidative stress (total antioxidant capacity [TAOC]) markers at 4 weeks was compared to baseline in two groups. RESULTS: A total of 90 patients (46 in AC group and 44 in AP group) completed the study and were included in the analysis. AP group demonstrated a significantly greater reduction in hs-CRP levels at 4 weeks compared to AC group (−7.17 ± 5.95 in AP vs. −4.10 ± 3.81 mg/L in AC groups, P = 0.002). A relatively greater increase in TAOC was also seen in AP group though statistically insignificant (184.25 ± 274.03 in AP vs. 126.67 ± 198.49 in AC groups, P = 0.117). Bleeding and adverse events were comparable in two groups. CONCLUSIONS: Prasugrel-based DAPT showed significantly greater reduction in inflammation compared to clopidogrel-based DAPT, with comparable antioxidant benefit and hematological safety indicating a greater pleiotropic benefit of prasugrel than clopidogrel.