Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: Systematic review and meta-analysis

Aradi, Dániel; Komócsi, András; Price, Matthew J.; Cuisset, Thomas; Arı, Hasan; Hazarbasanov, Dobri; Trenk, Dietmar; Sibbing, Dirk; Valgimigli, Marco; Bonello, Laurent

doi:10.1016/j.ijcard.2012.05.100

Cited by 125 publications

(78 citation statements)

References 26 publications

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“…A meta-analysis of 10 randomized clinical trials in which an intensified antiplatelet protocol based on adenosine diphosphate-specific platelet-reactivity testing was used found that the intensified protocol was associated with lower mortality and myocardial infarction rates; however, the benefit of intensified antiplatelet therapy was highly dependent on the patient's initial risk of stent thrombosis. 19 In a recent position paper by the Working Group of the European Society of Cardiology, high platelet reactivity (resistance to clopidogrel) was recognized as a marker for a high event rate during coronary intervention, especially during acute myocardial infarct intervention. 20 The use of alternative second antiplatelet agents such as prasugrel and ticagrelor has been recommended in such cases.…”

Section: Discussionmentioning

confidence: 99%

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device

Brinjikji¹,

Lanzino

Cloft

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device

Brinjikji¹,

Lanzino

Cloft

et al. 2015

AJNR Am J Neuroradiol

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“…Overall, the benefit of the intensified treatment was meaningful for patients at high risk of ST, while disappeared in low-risk individuals. The authors of the article also stated that the aggregometry approach is also more economical due to the high costs of administering new-generation ADP receptor antagonists [15].…”

Section: Evidence For Aggregometrymentioning

confidence: 99%

Most Recent Evidence Behind Aggregometry and Genotyping Methods as Platelet Function Testing for Tailored Anti-Platelet Treatment Among PCI Patients

Gajda¹,

Kołtowski²,

Tomaniak³

2015

Adv Clin Exp Med

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Aggregometry and genotyping are methods of platelet function testing, which can be beneficial for high-risk patients undergoing invasive cardiac procedures. An optimal level of platelet reactivity (PR) should be maintained. There are discrepancies between individuals and their response to clopidogrel, accounting for the incidence of poor responders from 5% to 44%. This phenomenon predisposes the patients to increased risk of ischaemic events and thereby overall poorer clinical outcome. Prasugrel and tricagrelor are newer without genetic correlation to their action, however associated with increased bleeding risk. Aggregometry methods assess platelet reactivity at the exact moment of blood sampling. They reflect "phenotype" of the patient and vary after drug administration or dose change. The most popular tests are Light Transmission Aggregometry, Vasodilator-Stimulated Protein, VerifyNow, Multiple Electrode Aggregometry and Thrombelastography. There is proven genetic correlation between some cytochrome enzymes on clopidogrel response. The most widely tested is gene CYP2C19, which produces the enzyme transforming clopidogrel into an active metabolite. The CYP2C19*2 allele carriers have higher PR which can result in more thrombotic events. The manuscript shows the most recent evidence behind platelet function testing. Aggregometry is shown to be beneficial in 5 trials and 1 meta-analysis, while one paper was of different opinion. Ten studies show a positive clinical effect of genotyping on patients' outcome, while one does not support it. The best method of identifying high-risk individuals could be both methods and personalisation of antiplatelet therapy may decrease adverse ischaemic outcomes (Adv Clin Exp Med 2015, 24, 4, 687-693).

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“…HPR patients exhibit a higher risk for ischaemic events including stent thrombosis (7,8,13). Platelet function testing (PFT) allows to monitor individual platelet reactivity and to adjust antiplatelet regimens potentially improving outcomes of HPR patients (17). Nevertheless, prior randomised trials (18)(19)(20) failed to show a clinical superiority of a PFT-guided antiplatelet therapy.…”

Section: Introductionmentioning

confidence: 99%

A randomised trial on platelet function-guided de-escalation of antiplatelet treatment in ACS patients undergoing PCI

Jacobshagen¹,

Groß²,

Trenk³

et al. 2017

Thromb Haemost

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SummaryOutcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) have been significantly improved with the use of potent P2Y12 receptor inhibitors like prasugrel. While most of the ischaemic risk reduction for prasugrel versus clopidogrel was demonstrated in the early treatment period, the risk of bleeding became particularly prominent during the chronic course of therapy. It may therefore be a valid approach to substitute prasugrel for clopidogrel in the early phase of chronic antiplatelet treatment after PCI. In the Testing Responsiveness To Platelet Inhibition On Chronic Antiplatelet Treatment For Acute Coronary Syndromes (TROPICAL-ACS) trial, we aim to compare standard prasugrel therapy with a de-escalating antiplatelet treatment approach guided by platelet function testing (PFT). The study is an investigator-initiated European multicentre, randomised clinical trial in biomarker-positive ACS patients after successful PCI. Two thousand six hundred patients will be randomised prior to hospital discharge in a 1:1 fashion to either receive standard prasugrel therapy (control group) or de-escalating therapy (one-week prasugrel followed by one-week clopidogrel and PFT-guided maintenance therapy from day 14 after hospital discharge, monitoring group). Patients of the monitoring group with high on-clopidogrel platelet reactivity (HPR) based on Multiplate analyzer testing (HPR: ≥ 46U per consensus definition) will be switched back to prasugrel, whereas those without HPR (<46 U) will continue clopidogrel treatment. The overall study treatment duration will be one year in both groups. The primary endpoint of the study is net clinical benefit (combined incidence of cardiovascular death, myocardial infarction, stroke and bleeding ≥ grade 2 according to BARC criteria) one-year after randomisation. TROPICAL-ACS is the first large-scale, randomised controlled trial assessing the clinical value of a PFT-guided de-escalation of antiplatelet treatment in biomarker positive ACS patients undergoing PCI.ClinicalTrials.gov Identifier: NCT01959451

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Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: Systematic review and meta-analysis

Cited by 125 publications

References 26 publications

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device

Most Recent Evidence Behind Aggregometry and Genotyping Methods as Platelet Function Testing for Tailored Anti-Platelet Treatment Among PCI Patients

A randomised trial on platelet function-guided de-escalation of antiplatelet treatment in ACS patients undergoing PCI

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