Policy default favoring prasugrel reduces bleeding in Swedish PCI registry

Health

tctmd.com

Researchers used a randomized policy design across seven Swedish regions to compare eras when ticagrelor or prasugrel were the recommended first-choice P2Y12 inhibitor after PCI for acute coronary syndromes. They analyzed 17,095 patients and found similar rates of death, myocardial infarction, or stroke at one year (11.8% with ticagrelor policy versus 11.1% with prasugrel policy; adjusted OR 0.90, 95% CI 0.77–1.06) and a modestly lower major bleeding rate with the prasugrel policy (4.2% versus 4.4%; adjusted OR 0.80, 95% CI 0.64–0.99). The trial randomized default policy rather than individual drug assignment and reflected real-world prescribing variations.

Prasugrel default policy cut major bleeding without raising ischemic events