Antiplatelet drugs and platelet reactivity: is it time to halt clinical research on tailored strategies?

Figures & data

Table 1. Selected past and ongoing randomized trials on platelet reactivity-based tailored antiplatelet therapy.

Study	Patients	Intervention	Event reduction	Strengths	Limitations
Bonello et al. (2009) [11]	429 PCI patients with NSTEMI and several risk factors	Up to four clopidogrel loading doses of 600 mg	Yes	Strong intervention prior to PCI; high-risk patients	Small size, delayed PCI
GRAVITAS (2011) [15]	2214 patients with PCI	600 mg re-loading post PCI and 150 mg/d for 6 months	No	Large sample	Low risk patients, limited impact of intervention on PR, low MACE rate
ARCTIC (2012) [16]	2440 patients with scheduled PCI and HPR	Various adjustments of antiplatelet drug dosing	No	Large sample, tailoring according to both aspirin and clopidogrel response	Low risk patients, <30% with ACS, low MACE rate
ANTARCTIC (2013) [25]	ACS patients aged 75 or more	Various adjustments of P2Y12 blocker therapy	Ongoing	High-risk patients (ACS, age>75y)	Actual vascular risk level and MACE incidence yet unknown
TROPICAL-ACS (2013)	ACS patients	Various adjustments of P2Y12 blocker therapy	Ongoing	ACS patients, combined incidence of bleeding and thrombotic events	Actual vascular risk level and MACE incidence yet unknown

ACS: Acute coronary syndrome; HPR: High platelet reactivity; MACE: Major adverse cardiovascular event; NSTEMI: Non-ST elevation myocardial infarction; PCI: Percutaneous coronary intervention.

Bonello L, Camoin-Jau L, Armero S, et al. Tailored clopidogrel loading dose according to platelet reactivity monitoring to prevent acute and subacute stent thrombosis. Am J Cardiol 2009;103(1):5-10

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Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011;305(11):1097-105

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Collet JP, Cuisset T, Range G, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 2012;367(22):2100-9

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Cayla G, Cuisset T, Silvain J, et al. Platelet function monitoring in elderly patients on prasugrel after stenting for an acute coronary syndrome: design of the randomized antarctic study. Am Heart J 2014;168(5):674-81

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