***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE It has been postulated that prasugrel might be the preferred treatment option in diabetes mellitus ( DM ) patients with acute coronary syndrome ( ACS ) undergoing percutaneous coronary intervention ( PCI ) . We aim ed to compare the pharmacodynamic action of ticagrelor versus prasugrel . RESEARCH DESIGN AND METHODS In a prospect i ve , single-center , single-blind , crossover study , 30 consecutive ACS patients with DM who had been pretreated with clopidogrel were r and omized to either 90 mg ticagrelor twice daily or 10 mg prasugrel once daily with a 15-day treatment period . Platelet reactivity ( PR ) was assessed with the VerifyNow P2Y12 function assay , measured in P2Y12 reaction units ( PRU ) . RESULTS PR was significantly lower after ticagrelor ( 45.2 PRU [ 95 % CI 27.4–63.1 ] ) compared with prasugrel ( 80.8 PRU [ 63.0–98.7 ] ) , with a least squares mean difference of –35.6 PRU ( −55.2 to −15.9 , P = 0.001 ) . High PR rate was 0 % for ticagrelor and 3.3 % for prasugrel ( P = 1.0 ) . CONCLUSIONS In DM patients with ACS who had been pretreated with clopidogrel and who undergo PCI , ticagrelor achieves a significantly higher platelet inhibition than prasugrel . Both antiplatelet agents effectively treat high PR . The relevance of these findings to the clinical efficacy and safety of ticagrelor and prasugrel in DM patients needs further elucidation BACKGROUND / PURPOSE Diabetes mellitus ( DM ) disproportionately affects Hispanic patients . DM patients have enhanced platelet reactivity and reduced sensitivity to clopidogrel . Ticagrelor demonstrated a more rapid onset and greater magnitude of platelet inhibition than clopidogrel in Hispanic patients with stable coronary artery disease ( CAD ) . This subgroup analysis examined the onset and level of platelet inhibition of ticagrelor and clopidogrel in Hispanic patients with DM . METHODS / MATERIAL S This was a subgroup analysis of a r and omized , open-label , crossover study in which 40 Hispanic patients with stable CAD received ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose ( MD ) then clopidogrel 600 mg LD/75 mg once-daily MD , or vice versa . The primary end point was on-treatment platelet reactivity at 2 hours post-LD using the VerifyNow ™ P2Y12 test . RESULTS 21 patients had DM and 19 were non-diabetic . At 2 hours post-LD , mean platelet reactivity in the diabetic group was 34.5 PRU with ticagrelor versus 219.3 PRU with clopidogrel ( P<0.001 ) , and in the non-diabetic group was 33.7 PRU with ticagrelor versus 181.0 PRU with clopidogrel ( P<0.001 ) . In both diabetic and non-diabetic subgroups , mean platelet reactivity declined to a significantly greater extent with ticagrelor than clopidogrel at all time points evaluated ( 0.5 , 2 , and 8 hours post LD and after 7 - 9 days of MD ) . Patients were significantly more likely to have high on-treatment platelet reactivity ( ≥208 PRU ) during treatment with clopidogrel compared with ticagrelor , regardless of diabetic status . CONCLUSIONS Among Hispanic patients with stable CAD , ticagrelor achieves a faster onset and greater magnitude of platelet inhibition compared with clopidogrel , irrespective of diabetic status OBJECTIVES Ticagrelor reduces thrombotic events compared with clopidogrel in patients with acute coronary syndrome , but may also increase bleeding complications . Coronary artery bypass grafting (CABG)-related bleeding complications have not previously been compared in clopidogrel and ticagrelor-treated patients outside the controlled environment of clinical trials . METHODS Four hundred and five consecutive CABG patients with acute coronary syndrome were included in a prospect i ve observational study . The patients were treated with aspirin and ticagrelor ( n = 173 ) or aspirin and clopidogrel ( n = 232 ) . Ticagrelor/clopidogrel was discontinued 5 days before surgery whenever deemed possible . Major bleeding complications according to modified blood conservation using antifibrinolytics in a r and omized trial criteria ( postoperative blood loss > 1500 ml/12 h , re-exploration , red blood cell transfusion > 10 units or death because of bleeding ) were compared in all patients and when ticagrelor/clopidogrel was discontinued ≥5 days ( n = 280 ) , 2 - 4 days ( n = 40 ) or 0 - 1 day before surgery ( n = 85 ) . RESULTS Major bleeding complications did not differ significantly between ticagrelor- and clopidogrel-treated patients when all patients were compared ( 14.5 vs 13.8 % , P = 0.89 ) . Likewise , there were no significant differences between ticagrelor and clopidogrel when either drug was discontinued ≥5 days before surgery ( 6.8 vs 9.9 % , P = 0.40 ) or 2 - 4 days before surgery ( 6.3 vs 25.0 % , P = 0.21 ) . When ticagrelor/clopidogrel was discontinued 0 - 1 day before surgery , there was a strong trend towards higher incidence of major bleeding in ticagrelor-treated patients ( 41.0 vs 21.7 % , P = 0.063 ) . CONCLUSIONS There was no difference in major bleeding complications overall or when ticagrelor or clopidogrel was used in accordance with guidelines . In patients on dual antiplatelet medication up to 1 day before surgery , there tended to be more bleeding complications in ticagrelor-treated patients BACKGROUND Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention . METHODS To compare prasugrel , a new thienopyridine , with clopidogrel , we r and omly assigned 13,608 patients with moderate-to-high-risk acute coronary syndromes with scheduled percutaneous coronary intervention to receive prasugrel ( a 60-mg loading dose and a 10-mg daily maintenance dose ) or clopidogrel ( a 300-mg loading dose and a 75-mg daily maintenance dose ) , for 6 to 15 months . The primary efficacy end point was death from cardiovascular causes , nonfatal myocardial infa rct ion , or nonfatal stroke . The key safety end point was major bleeding . RESULTS The primary efficacy end point occurred in 12.1 % of patients receiving clopidogrel and 9.9 % of patients receiving prasugrel ( hazard ratio for prasugrel vs. clopidogrel , 0.81 ; 95 % confidence interval [ CI ] , 0.73 to 0.90 ; P<0.001 ) . We also found significant reductions in the prasugrel group in the rates of myocardial infa rct ion ( 9.7 % for clopidogrel vs. 7.4 % for prasugrel ; P<0.001 ) , urgent target-vessel revascularization ( 3.7 % vs. 2.5 % ; P<0.001 ) , and stent thrombosis ( 2.4 % vs. 1.1 % ; P<0.001 ) . Major bleeding was observed in 2.4 % of patients receiving prasugrel and in 1.8 % of patients receiving clopidogrel ( hazard ratio , 1.32 ; 95 % CI , 1.03 to 1.68 ; P=0.03 ) . Also greater in the prasugrel group was the rate of life-threatening bleeding ( 1.4 % vs. 0.9 % ; P=0.01 ) , including nonfatal bleeding ( 1.1 % vs. 0.9 % ; hazard ratio , 1.25 ; P=0.23 ) and fatal bleeding ( 0.4 % vs. 0.1 % ; P=0.002 ) . CONCLUSIONS In patients with acute coronary syndromes with scheduled percutaneous coronary intervention , prasugrel therapy was associated with significantly reduced rates of ischemic events , including stent thrombosis , but with an increased risk of major bleeding , including fatal bleeding . Overall mortality did not differ significantly between treatment groups . ( Clinical Trials.gov number , NCT00097591 [ Clinical Trials.gov ] . BACKGROUND Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes . We compared ticagrelor , a more potent reversible P2Y12 inhibitor with clopidogrel in such patients . METHODS At r and omisation , an invasive strategy was planned for 13 408 ( 72.0 % ) of 18 624 patients hospitalised for acute coronary syndromes ( with or without ST elevation ) . In a double-blind , double-dummy study , patients were r and omly assigned in a one-to-one ratio to ticagrelor and placebo ( 180 mg loading dose followed by 90 mg twice a day ) , or to clopidogrel and placebo ( 300 - 600 mg loading dose or continuation with maintenance dose followed by 75 mg per day ) for 6 - 12 months . All patients were given aspirin . The primary composite endpoint was cardiovascular death , myocardial infa rct ion , or stroke . Analyses were by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00391872 . FINDINGS 6732 patients were assigned to ticagrelor and 6676 to clopidogrel . The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group ( 569 [ event rate at 360 days 9.0 % ] vs 668 [ 10.7 % ] , hazard ratio 0.84 , 95 % CI 0.75 - 0.94 ; p=0.0025 ) . There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding ( 691 [ 11.6 % ] vs 689 [ 11.5 % ] , 0.99 [ 0.89 - 1.10 ] ; p=0.8803 ) or severe bleeding , as defined according to the Global Use of Strategies To Open occluded coronary arteries , ( 198 [ 3.2 % ] vs 185 [ 2.9 % ] , 0.91 [ 0.74 - 1.12 ] ; p=0.3785 ) . INTERPRETATION Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned Background : No r and omized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y12 inhibitors were first demonstrated relative to clopidogrel . Methods : This academic study was design ed to compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infa rct ion treated with primary or immediate percutaneous coronary intervention . A total of 1230 patients were r and omly assigned across 14 sites to either prasugrel or ticagrelor  , which was initiated before percutaneous coronary intervention . Nearly 4 % were in cardiogenic shock , and 5.2 % were on mechanical ventilation . The primary end point was defined as death , reinfa rct ion , urgent target vessel revascularization , stroke , or serious bleeding requiring transfusion or prolonging hospitalization at 7 days ( to reflect primarily the in-hospital phase ) . This analysis presents data from the first 30 days ( key secondary end point ) . The total follow-up will be 1 year for all patients and will be completed in 2017 . Results : The study was prematurely terminated for futility . The occurrence of the primary end point did not differ between groups receiving prasugrel and ticagrelor ( 4.0 % and 4.1 % , respectively ; odds ratio , 0.98 ; 95 % confidence interval , 0.55–1.73 ; P=0.939 ) . No significant difference was found in any of the components of the primary end point . The occurrence of key secondary end point within 30 days , composed of cardiovascular death , nonfatal myocardial infa rct ion , or stroke , did not show any significant difference between prasugrel and ticagrelor ( 2.7 % and 2.5 % , respectively ; odds ratio , 1.06 ;  
    Output:
    
Ticagrelor could reduce the incidence of composite endpoint of cardiovascular death , myocardial infa rct ion and stroke as well as platelet reactivity in DM patients with ACS , while not increasing the risk of bleeding .