Comparative evaluation of anti-inflammatory and antioxidant effects of prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention: A prospective cohort study.
Vinayagam S, Mittal N, et al. • Indian journal of pharmacology • 2026
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.
Key Findings
Results
Prasugrel-based dual antiplatelet therapy produced a significantly greater reduction in hs-CRP levels at 4 weeks compared to clopidogrel-based therapy in ACS patients undergoing PCI.
Mean change in hs-CRP was -7.17 ± 5.95 mg/L in the aspirin + prasugrel (AP) group versus -4.10 ± 3.81 mg/L in the aspirin + clopidogrel (AC) group
The difference was statistically significant (P = 0.002)
Measurement was taken at 4 weeks compared to baseline
90 patients completed the study (46 in AC group, 44 in AP group)
Results
Prasugrel-based DAPT produced a greater increase in total antioxidant capacity (TAOC) compared to clopidogrel-based DAPT, though the difference was not statistically significant.
Mean change in TAOC was 184.25 ± 274.03 in the AP group versus 126.67 ± 198.49 in the AC group
The difference was not statistically significant (P = 0.117)
The authors described this as 'a relatively greater increase in TAOC' in the prasugrel group
TAOC was measured at 4 weeks compared to baseline
Results
Bleeding and adverse events were comparable between the prasugrel and clopidogrel treatment groups.
The study assessed hematological safety in both groups
No statistically significant differences in bleeding or adverse events were reported between the AC and AP groups
The authors characterized the safety profile as 'comparable hematological safety'
Both groups received aspirin as the backbone of DAPT
Methods
This was a prospective cohort study enrolling ACS patients aged 18-65 years undergoing PCI who were eligible for dual antiplatelet therapy.
Initial enrollment was 52 patients per group (n = 104 total)
90 patients completed the study: 46 in the AC group and 44 in the AP group
The two groups were aspirin + clopidogrel (AC group) and aspirin + prasugrel (AP group)
Inflammatory marker hs-CRP and oxidative stress marker TAOC were assessed at baseline and 4 weeks
What This Means
This research suggests that for patients who have had a heart attack or acute coronary syndrome and underwent a procedure to open blocked arteries (PCI), the choice of blood thinner used alongside aspirin may influence inflammation levels in the body. Specifically, patients who received prasugrel (combined with aspirin) showed a significantly larger drop in a key inflammation marker called hs-CRP after 4 weeks compared to those who received clopidogrel (combined with aspirin). Both clopidogrel and prasugrel are medications that prevent blood clots by reducing platelet activity, but this study suggests prasugrel may have additional benefits beyond clot prevention.
The study also measured antioxidant capacity — a measure of the body's ability to fight harmful oxidative stress — and found that prasugrel patients showed a greater improvement, though this difference was not large enough to be statistically conclusive. Importantly, the rates of bleeding and other adverse events were similar between the two groups, suggesting that the potential anti-inflammatory advantage of prasugrel did not come at the cost of increased safety risks in this study population.
This research matters because inflammation plays a major role in the progression of heart disease, and medications that reduce both clotting and inflammation could offer added protective benefits. The findings add to a growing body of evidence about 'pleiotropic' (beyond the primary intended) effects of antiplatelet drugs, though larger randomized trials would be needed to confirm these results and determine whether the observed differences translate into meaningful long-term clinical outcomes for patients.
Vinayagam S, Mittal N, Kumar A, Kumawat M, Parmar A, Kalra V, et al.. (2026). Comparative evaluation of anti-inflammatory and antioxidant effects of prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention: A prospective cohort study.. Indian journal of pharmacology. https://doi.org/10.4103/ijp.ijp_3_26