Abstract
Background Peri-procedural platelet reactivity (PR) inhibition is critical in patients undergoing percutaneous coronary intervention (PCI). High on-treatment PR (HTPR) was associated with recurrent ischemic events in acute coronary syndrome (ACS) patients undergoing PCI. We aimed to compare a strategy of clopidogrel loading dose-adjustment (CDA) according to PR monitoring with standard prasugrel therapy to reduce the rate of patients exhibiting HTPR. Methods We enrolled 177 ACS patients in a prospective multicentre randomized trial comparing CDA according to PR monitoring and prasugrel therapy. The VASP index was used to measure PR and a VASP ≥ 50% defined HTPR. The primary endpoint of the study was the rate of HTPR on discharge. Results Baseline characteristics of the CDA group (n = 88) and of the prasugrel group (n = 89) were similar. CDA significantly reduced PR and the rate of HTPR compared to a single LD of clopidogrel (30.9 ± 13.9%; p <0.0001 and 43 to 2.3%; p <0.001, respectively). Following CDA the rate of patients with HTPR was significantly lower in the CDA group compared to the prasugrel group on discharge (2.3 vs 15.7%; p = 0.005). In addition fewer patients in the CDA group had a VASP <16% on discharge (14.7 vs 50.5%; p <0.0001). Conclusion In the present study, PR monitoring was superior to standard prasugrel therapy to reduce the rate of HTPR in ACS patients. In addition such strategy reduced the number of patients with very low PR.
| Original language | English |
|---|---|
| Pages (from-to) | 4244-4248 |
| Number of pages | 5 |
| Journal | International Journal of Cardiology |
| Volume | 168 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 9 2013 |
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Keywords
- Acute coronary syndrome
- Bleeding
- Platelet reactivity monitoring
- Stent thrombosis
- VASP
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity. / Bonello, Laurent; Laine, Marc; Baumstarck, Karine; Fernandez, Jessica; Maillard, Luc; Peyrol, Michael; Bessereau, Jacques; Aradi, D.; Camilleri, Elise; Roubille, François; Piot, Christophe; Paganelli, Franck; Camoin-Jau, Laurence; Dignat-George, Françoise.
In: International Journal of Cardiology, Vol. 168, No. 4, 09.10.2013, p. 4244-4248.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity
AU - Bonello, Laurent
AU - Laine, Marc
AU - Baumstarck, Karine
AU - Fernandez, Jessica
AU - Maillard, Luc
AU - Peyrol, Michael
AU - Bessereau, Jacques
AU - Aradi, D.
AU - Camilleri, Elise
AU - Roubille, François
AU - Piot, Christophe
AU - Paganelli, Franck
AU - Camoin-Jau, Laurence
AU - Dignat-George, Françoise
PY - 2013/10/9
Y1 - 2013/10/9
N2 - Background Peri-procedural platelet reactivity (PR) inhibition is critical in patients undergoing percutaneous coronary intervention (PCI). High on-treatment PR (HTPR) was associated with recurrent ischemic events in acute coronary syndrome (ACS) patients undergoing PCI. We aimed to compare a strategy of clopidogrel loading dose-adjustment (CDA) according to PR monitoring with standard prasugrel therapy to reduce the rate of patients exhibiting HTPR. Methods We enrolled 177 ACS patients in a prospective multicentre randomized trial comparing CDA according to PR monitoring and prasugrel therapy. The VASP index was used to measure PR and a VASP ≥ 50% defined HTPR. The primary endpoint of the study was the rate of HTPR on discharge. Results Baseline characteristics of the CDA group (n = 88) and of the prasugrel group (n = 89) were similar. CDA significantly reduced PR and the rate of HTPR compared to a single LD of clopidogrel (30.9 ± 13.9%; p <0.0001 and 43 to 2.3%; p <0.001, respectively). Following CDA the rate of patients with HTPR was significantly lower in the CDA group compared to the prasugrel group on discharge (2.3 vs 15.7%; p = 0.005). In addition fewer patients in the CDA group had a VASP <16% on discharge (14.7 vs 50.5%; p <0.0001). Conclusion In the present study, PR monitoring was superior to standard prasugrel therapy to reduce the rate of HTPR in ACS patients. In addition such strategy reduced the number of patients with very low PR.
AB - Background Peri-procedural platelet reactivity (PR) inhibition is critical in patients undergoing percutaneous coronary intervention (PCI). High on-treatment PR (HTPR) was associated with recurrent ischemic events in acute coronary syndrome (ACS) patients undergoing PCI. We aimed to compare a strategy of clopidogrel loading dose-adjustment (CDA) according to PR monitoring with standard prasugrel therapy to reduce the rate of patients exhibiting HTPR. Methods We enrolled 177 ACS patients in a prospective multicentre randomized trial comparing CDA according to PR monitoring and prasugrel therapy. The VASP index was used to measure PR and a VASP ≥ 50% defined HTPR. The primary endpoint of the study was the rate of HTPR on discharge. Results Baseline characteristics of the CDA group (n = 88) and of the prasugrel group (n = 89) were similar. CDA significantly reduced PR and the rate of HTPR compared to a single LD of clopidogrel (30.9 ± 13.9%; p <0.0001 and 43 to 2.3%; p <0.001, respectively). Following CDA the rate of patients with HTPR was significantly lower in the CDA group compared to the prasugrel group on discharge (2.3 vs 15.7%; p = 0.005). In addition fewer patients in the CDA group had a VASP <16% on discharge (14.7 vs 50.5%; p <0.0001). Conclusion In the present study, PR monitoring was superior to standard prasugrel therapy to reduce the rate of HTPR in ACS patients. In addition such strategy reduced the number of patients with very low PR.
KW - Acute coronary syndrome
KW - Bleeding
KW - Platelet reactivity monitoring
KW - Stent thrombosis
KW - VASP
UR - http://www.scopus.com/inward/record.url?scp=84886305756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84886305756&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2013.07.147
DO - 10.1016/j.ijcard.2013.07.147
M3 - Article
VL - 168
SP - 4244
EP - 4248
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 4
ER -