Studies have linked on-treatment platelet reactivity (PR) to adverse clinical outcomes. Because new P2Y12 inhibitors (
prasugrel and
ticagrelor) have been predominantly tested against
clopidogrel, data on pharmacodynamic comparisons between these 2 drugs are scarce. We compared
ticagrelor with
prasugrel in a network meta-analysis. PubMed, Cochrane, and EMBASE were searched for studies assessing PR in patients with
coronary artery disease treated with
ticagrelor or
prasugrel. All studies using
prasugrel and/or
ticagrelor providing platelet function measurement data using VerifyNow P2Y12 reaction units (PRUs), platelet reactivity index (PRI)
vasodilator-stimulated phosphoprotein phosphorylation, or maximal platelet aggregation (MPA) by light transmission aggregometry were considered eligible. Mixed treatment comparison models directly compared
ticagrelor and
prasugrel and indirectly compared them using
clopidogrel as a comparator with data presented as mean difference (95% confidence interval). Data were extracted from 29 studies, including 5,395 patients. Compared with
clopidogrel 75 mg, both
prasugrel 10 mg and
ticagrelor 90 mg twice daily were associated with lower PRU (mean difference -117 [-134.1, -100.5] and -159.7 [-182.6, -136.6], respectively), a lower PRI (-24.2 [-28.2, -20.3] and -33.6 [-39.9, -27.6], respectively), and lower MPA (-11.8 [-17, -6.3] and -20.7 [-28.5, -12.8], respectively). Similar results were obtained with
clopidogrel 150 mg.
Ticagrelor 90 mg twice daily was associated with lower PRU (-42.5 [-62.9, -21.9]), lower PRI (-9.3 [-15.6, -3.5]), and lower MPA (-8.9 [-16.4, -1.2]) compared with
prasugrel 10 mg. In conclusion, our meta-analysis suggests that
ticagrelor achieved significantly lower on-treatment PR compared with
prasugrel, with both being superior to
clopidogrel standard or high dose.