Like clopidogrel, both prasu- grel and ticagrelor inhibit the platelet P2Y12 adenosine diphos- phate receptor, but they have a more rapid onset of action and more consistent and pronounced platelet inhibition than clopi- Prasugrel was first evaluated in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) study, in which 13608 patients presenting with acute coronary syndromes were ran- domized to receive aspirin plus clopidogrel 75 mg daily or aspirin plus prasugrel 10 mg daily for 6 to 15 months. The pri- mary outcome (cardiovascular death, nonfatal MI, or stroke) was significantly reduced for patients who received prasugrel although major bleeding complications were observed more frequently with prasugrel (2.4% versus 1.8%, prasugrel versus In a post hoc analysis of the 346 ran- domized patients in the TRITON-TIMI 38 study who under- went CABG, prasugrel was associated with a lower rate of death after CABG compared with clopidogrel (adjusted OR, 0.26; P=0.025). However, prasugrel led to more blood loss after surgery (P=0.05).50 The use of ticagrelor for the treatment of acute coronary syndrome was assessed in the Platelet Inhibition and Patient Outcomes (PLATO) study, a randomized trial comparing 1-year treatment with aspirin plus ticagrelor 90 mg twice daily with aspirin plus clopidogrel 75 mg daily in 18624 patients. The primary end point of the study (cardiovascular death, MI, or stroke) was significantly reduced by ticagrelor (9.8% versus 11.7%, ticagrelor versus clopidogrel; P<0.001), but ticagrelor was associated with a higher rate of major bleeding (4.5% versus 3.8%, ticagrelor versus clopidogrel; P=0.03). The trial investigators thereafter performed a post hoc analysis of the 1261 patients who underwent CABG within 7 days of receiv- ing study drug treatment in PLATO. 