Pleotropic Effects of Clopidogrel and Prasugrel on Inflammatory and Oxidative Stress Markers in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Controlled Clinical Trial (CLAP-INOX Trial)

Background: /Objectives: While both clopidogrel and prasugrel inhibit platelet aggregation, their comparative pleiotropic effects on inflammatory and oxidative stress markers remain unclear. We aimed to compare the anti-inflammatory and antioxidant potential of clopidogrel and prasugrel given as dual antiplatelet therapy (DAPT) along with aspirin in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Methods: This was an investigator initiated, randomized, open-label, parallel-group con-trolled clinical trial. Patients aged 18–65 years undergoing PCI for ACS and eligible candidates for DAPT were randomised in 1:1 ratio to aspirin + clopidogrel (AC group) or aspirin + prasugrel (AP group). Primary objective was comparison of change in inflammatory (high sensitivity C reactive protein; hs-CRP) and oxida-tive stress (total antioxidant capacity; TAOC) markers at 4 weeks from baseline between the two groups. Secondary outcomes were incidence and severity of bleeding episodes and treatment related adverse events or therapy discontinuation. Data was subjected to per-protocol analysis. Statistical significance was defined as p< 0.05. Results: A total of 90 patients (46 in AC and 44 in AP groups) were available for PP analysis. AP group demonstrated a significantly greater reduction in hs-CRP levels at 4 weeks compared to AC group (p = 0.002). A relatively greater increase in TAOC was also seen in AP group though statistically insignificant (p = 0.117). The incidence of bleeding and adverse events was comparable in both the groups. Conclusions: Prasu-grel based DAPT showed significantly greater reduction in inflammation compared to clopidogrel based DAPT, with comparable antioxidant benefit and hematological safety. These findings support a greater addi-tional pleiotropic benefit of prasugrel than clopidogrel in ACS patients undergoing PCI.