Do you favor ticagrelor or prasugrel first-line for the treatment of ACS with planned PCI, provided no contraindications to either agent?

I prefer Prasugrel based on the latest data from ISAR-REACT 5 trial. I almost never use ticagrelor as it is expensive and there are significant side effects (Shortness of breath being the most common).

Assuming this question relates to oral, non-ASA antiplatelet therapies, ticagrelor is a fast onset, high antiplatelet efficacy, non-hepatic first pass requiring (can be given per rectal route if needed in cases of vomiting, etc.), comparative offset agent. It’s adenosine reuptake-related SOB effects...

The data suggest that ticagrelor and prasugrel are preferred over clopidogrel in ACS, albeit with increased hazard of bleeding complications. In one of the few head-to-head comparison trials in ACS, ISAR-REACT 5, prasugrel had increased efficacy over ticagrelor. Based on the best available data, it ...