title: Bedside monitoring to adjust antiplatelet therapy for coronary stenting.
abstract: BACKGROUND
  Patients' responses to oral antiplatelet therapy are subject to variation. Bedside monitoring offers the opportunity to improve outcomes after coronary stenting by individualizing therapy.
  
  
  METHODS
  We randomly assigned 2440 patients scheduled for coronary stenting at 38 centers to a strategy of platelet-function monitoring, with drug adjustment in patients who had a poor response to antiplatelet therapy, or to a conventional strategy without monitoring and drug adjustment. The primary end point was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation. For patients in the monitoring group, the VerifyNow P2Y12 and aspirin point-of-care assays were used in the catheterization laboratory before stent implantation and in the outpatient clinic 2 to 4 weeks later.
  
  
  RESULTS
  In the monitoring group, high platelet reactivity in patients taking clopidogrel (34.5% of patients) or aspirin (7.6%) led to the administration of an additional bolus of clopidogrel, prasugrel, or aspirin along with glycoprotein IIb/IIIa inhibitors during the procedure. The primary end point occurred in 34.6% of the patients in the monitoring group, as compared with 31.1% of those in the conventional-treatment group (hazard ratio, 1.13; 95% confidence interval [CI], 0.98 to 1.29; P=0.10). The main secondary end point, stent thrombosis or any urgent revascularization, occurred in 4.9% of the patients in the monitoring group and 4.6% of those in the conventional-treatment group (hazard ratio, 1.06; 95% CI, 0.74 to 1.52; P=0.77). The rate of major bleeding events did not differ significantly between groups.
  
  
  CONCLUSIONS
  This study showed no significant improvements in clinical outcomes with platelet-function monitoring and treatment adjustment for coronary stenting, as compared with standard antiplatelet therapy without monitoring. (Funded by Allies in Cardiovascular Trials Initiatives and Organized Networks and others; ARCTIC ClinicalTrials.gov number, NCT00827411.).
authors.affiliation: Institut de Cardiologie Hôpital Pitié–Salpêtrière and Université Pierre et Marie Curie, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Grégoire
authors.initials: G
authors.lastname: Rangé
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.forename: Simon
authors.initials: S
authors.lastname: Elhadad
authors.forename: Christophe
authors.initials: C
authors.lastname: Pouillot
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Ziad
authors.initials: Z
authors.lastname: Boueri
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Hélène
authors.initials: H
authors.lastname: Rousseau
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.forename: Jacques
authors.initials: J
authors.lastname: Monségu
authors.forename: Pierre
authors.initials: P
authors.lastname: Sabouret
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.forename: Jérémie
authors.initials: J
authors.lastname: Abtan
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.forename: Christophe
authors.initials: C
authors.lastname: Saint-Etienne
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010879:Piperazines / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019095:Point-of-Care Systems; D000068799:Prasugrel Hydrochloride; D011725:Pyridines / Q000008:administration & dosage; D019233:Retreatment; D015607:Stents / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; C446540:thienopyridine; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin