Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy
Background: In the ARCTIC trial (Assessment by a Double Randomization of a Conventional Antiplatelet Strategy Versus a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation and of Treatment Interruption Versus Continuation One Year After Stenting), treatment adjustment following platelet fu...
Published in: | Circulation: Cardiovascular Interventions |
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Format: | Article in Journal/Newspaper |
Language: | English |
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Ovid Technologies (Wolters Kluwer Health)
2019
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Online Access: | http://dx.doi.org/10.1161/circinterventions.118.007749 https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.118.007749 |
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crovidcr:10.1161/circinterventions.118.007749 2023-10-01T03:53:48+02:00 Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy Pharmacodynamic Insights From the ARCTIC Study Lattuca, Benoit Silvain, Johanne Yan, Yan Pouillot, Christophe Cuisset, Thomas Cayla, Guillaume Henry, Patrick Diallo, Abdourahmane Elhadad, Simon Rangé, Grégoire Lhermusier, Thibault Boueri, Ziad Motreff, Pascal Carrié, Didier Vicaut, Eric Montalescot, Gilles Collet, Jean-Philippe 2019 http://dx.doi.org/10.1161/circinterventions.118.007749 https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.118.007749 en eng Ovid Technologies (Wolters Kluwer Health) Circulation: Cardiovascular Interventions volume 12, issue 11 ISSN 1941-7640 1941-7632 Cardiology and Cardiovascular Medicine journal-article 2019 crovidcr https://doi.org/10.1161/circinterventions.118.007749 2023-09-01T11:07:28Z Background: In the ARCTIC trial (Assessment by a Double Randomization of a Conventional Antiplatelet Strategy Versus a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation and of Treatment Interruption Versus Continuation One Year After Stenting), treatment adjustment following platelet function testing failed to improve clinical outcomes. However, high-on-treatment platelet reactivity (HPR) is considered as a predictor of poor ischemic outcome. This prespecified substudy evaluated clinical outcomes according to the residual platelet reactivity status after antiplatelet therapy adjustment. Methods: We analyzed the 1213 patients assigned to the monitoring arm of the ARCTIC trial in whom platelet reactivity was evaluated by the VerifyNow P2Y 12 test before percutaneous coronary intervention and during the maintenance phase (at 14 days). HPR was defined as platelet reaction unit≥235U. The primary ischemic end point, a composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization and the safety end point of major bleeding were assessed according to the platelet reactivity status. Results: Before percutaneous coronary intervention, 35.7% of patients displayed HPR (n=419). During the acute phase, between percutaneous coronary intervention and the 14-day platelet function testing, ischemic (adjusted hazard ratio, 0.94 [95% CI, 0.74–1.18]; P =0.58) and safety outcomes (hazard ratio, 1.28 [95% CI, 0.22–7.59]; P =0.78) were similar in HPR and non-HPR patients. During the maintenance phase, the proportion of HPR patients (n=186, 17.4%) decreased by 56%. At 1-year, there was no difference for the ischemic end point (5.9% versus 6.0%; adjusted hazard ratio, 0.79 [95% CI, 0.40–1.58]; P =0.51) and a nonsignificant higher rate of major bleedings (2.7% versus 1.0%, hazard ratio, 2.83 [95% CI, 0.96–8.41]; P =0.06) in HPR versus non-HPR patients. Conclusions: The proportion of HPR was halved after platelet function testing and treatment adjustment but without significant ischemic ... Article in Journal/Newspaper Arctic Ovid (via Crossref) Arctic Stent ENVELOPE(156.333,156.333,-81.250,-81.250) Circulation: Cardiovascular Interventions 12 11 |
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collection |
Ovid (via Crossref) |
op_collection_id |
crovidcr |
language |
English |
topic |
Cardiology and Cardiovascular Medicine |
spellingShingle |
Cardiology and Cardiovascular Medicine Lattuca, Benoit Silvain, Johanne Yan, Yan Pouillot, Christophe Cuisset, Thomas Cayla, Guillaume Henry, Patrick Diallo, Abdourahmane Elhadad, Simon Rangé, Grégoire Lhermusier, Thibault Boueri, Ziad Motreff, Pascal Carrié, Didier Vicaut, Eric Montalescot, Gilles Collet, Jean-Philippe Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
topic_facet |
Cardiology and Cardiovascular Medicine |
description |
Background: In the ARCTIC trial (Assessment by a Double Randomization of a Conventional Antiplatelet Strategy Versus a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation and of Treatment Interruption Versus Continuation One Year After Stenting), treatment adjustment following platelet function testing failed to improve clinical outcomes. However, high-on-treatment platelet reactivity (HPR) is considered as a predictor of poor ischemic outcome. This prespecified substudy evaluated clinical outcomes according to the residual platelet reactivity status after antiplatelet therapy adjustment. Methods: We analyzed the 1213 patients assigned to the monitoring arm of the ARCTIC trial in whom platelet reactivity was evaluated by the VerifyNow P2Y 12 test before percutaneous coronary intervention and during the maintenance phase (at 14 days). HPR was defined as platelet reaction unit≥235U. The primary ischemic end point, a composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization and the safety end point of major bleeding were assessed according to the platelet reactivity status. Results: Before percutaneous coronary intervention, 35.7% of patients displayed HPR (n=419). During the acute phase, between percutaneous coronary intervention and the 14-day platelet function testing, ischemic (adjusted hazard ratio, 0.94 [95% CI, 0.74–1.18]; P =0.58) and safety outcomes (hazard ratio, 1.28 [95% CI, 0.22–7.59]; P =0.78) were similar in HPR and non-HPR patients. During the maintenance phase, the proportion of HPR patients (n=186, 17.4%) decreased by 56%. At 1-year, there was no difference for the ischemic end point (5.9% versus 6.0%; adjusted hazard ratio, 0.79 [95% CI, 0.40–1.58]; P =0.51) and a nonsignificant higher rate of major bleedings (2.7% versus 1.0%, hazard ratio, 2.83 [95% CI, 0.96–8.41]; P =0.06) in HPR versus non-HPR patients. Conclusions: The proportion of HPR was halved after platelet function testing and treatment adjustment but without significant ischemic ... |
format |
Article in Journal/Newspaper |
author |
Lattuca, Benoit Silvain, Johanne Yan, Yan Pouillot, Christophe Cuisset, Thomas Cayla, Guillaume Henry, Patrick Diallo, Abdourahmane Elhadad, Simon Rangé, Grégoire Lhermusier, Thibault Boueri, Ziad Motreff, Pascal Carrié, Didier Vicaut, Eric Montalescot, Gilles Collet, Jean-Philippe |
author_facet |
Lattuca, Benoit Silvain, Johanne Yan, Yan Pouillot, Christophe Cuisset, Thomas Cayla, Guillaume Henry, Patrick Diallo, Abdourahmane Elhadad, Simon Rangé, Grégoire Lhermusier, Thibault Boueri, Ziad Motreff, Pascal Carrié, Didier Vicaut, Eric Montalescot, Gilles Collet, Jean-Philippe |
author_sort |
Lattuca, Benoit |
title |
Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
title_short |
Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
title_full |
Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
title_fullStr |
Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
title_full_unstemmed |
Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy |
title_sort |
reasons for the failure of platelet function testing to adjust antiplatelet therapy |
publisher |
Ovid Technologies (Wolters Kluwer Health) |
publishDate |
2019 |
url |
http://dx.doi.org/10.1161/circinterventions.118.007749 https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.118.007749 |
long_lat |
ENVELOPE(156.333,156.333,-81.250,-81.250) |
geographic |
Arctic Stent |
geographic_facet |
Arctic Stent |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Circulation: Cardiovascular Interventions volume 12, issue 11 ISSN 1941-7640 1941-7632 |
op_doi |
https://doi.org/10.1161/circinterventions.118.007749 |
container_title |
Circulation: Cardiovascular Interventions |
container_volume |
12 |
container_issue |
11 |
_version_ |
1778520754147557376 |