LAUSR

Dear Editor, Recently, Schüpke and colleagues performed an investigator-initiated head-to-head trial on prasugrel versus ticagrelor in acute coronary syndrome [1]. We highly commend the authors for performing such study. Certainly, given the earlier trials comparing prasugrel and ticagrelor to clopidogrel [2, 3], which influencedmany national guidelines, these trials [2, 3] demonstrated absolute risk reductions of 2% for both ticagrelor and prasugrel versus clopidogrel. It was now shown that prasugrel led to lower primary endpoint (i.e., 12and 15-monthmortality) than ticagrelor. As a thought experiment, we wondered whether the results of the three trials could be reconciled to make a practice recommendation. For this reason, in this letter, we present a reflection of our journey in achieving this purpose.