A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity

Laurent Bonello, Marc Laine, Karine Baumstarck, Jessica Fernandez, Luc Maillard, Michael Peyrol, Jacques Bessereau, D. Aradi, Elise Camilleri, François Roubille, Christophe Piot, Franck Paganelli, Laurence Camoin-Jau, Françoise Dignat-George

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 languageEnglish
Pages (from-to)4244-4248
Number of pages5
JournalInternational Journal of Cardiology
Volume168
Issue number4
DOIs
Publication statusPublished - Oct 9 2013

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clopidogrel
Blood Platelets
Acute Coronary Syndrome
Therapeutics
Percutaneous Coronary Intervention
Prasugrel Hydrochloride

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 journalArticle

Bonello, L, Laine, M, Baumstarck, K, Fernandez, J, Maillard, L, Peyrol, M, Bessereau, J, Aradi, D, Camilleri, E, Roubille, F, Piot, C, Paganelli, F, Camoin-Jau, L & Dignat-George, F 2013, 'A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity', International Journal of Cardiology, vol. 168, no. 4, pp. 4244-4248. https://doi.org/10.1016/j.ijcard.2013.07.147
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. / A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 4. pp. 4244-4248.
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title = "A randomized trial of platelet reactivity monitoring-adjusted clopidogrel therapy versus prasugrel therapy to reduce high on-treatment platelet reactivity",
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.",
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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

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