A large retrospective study from a tertiary hospital has found that more potent P2Y12 inhibitors like ticagrelor or prasugrel may offer better protection against ischemic events in cancer patients undergoing PCI, without a meaningful increase in bleeding risk. 

The findings, published in the Canadian Journal of Cardiology, included 1,702 patients treated between 2012 and 2022. Roughly 22% received potent P2Y12 drugs, while most others were treated with clopidogrel. Those receiving the stronger agents tended to be younger, more likely to have acute coronary syndrome, and less likely to have active cancer or bleeding risk factors like thrombocytopenia.
 

At one-year follow-up, the group on potent P2Y12 inhibitors had a lower rate of death, stroke, or heart attack (3.5%) compared to the clopidogrel group (6.8%). However, after adjusting for baseline characteristics, the difference was no longer statistically significant. Importantly, bleeding rates remained similar across both groups, and patients in cancer remission seemed to benefit the most.