title: Thrombotic and bleeding events after coronary stenting according to clopidogrel and aspirin platelet reactivity: VerifyNow French Registry (VERIFRENCHY).
abstract: BACKGROUND
  Dual antiplatelet therapy, comprising aspirin and clopidogrel, is recommended in patients undergoing coronary stenting to avoid the occurrence of stent thrombosis and others ischaemic events. Interindividual response to clopidogrel varies, however, with poor response associated with an increased risk of ischaemic events. New assays are available for testing aspirin and clopidogrel response routinely at the bedside.
  
  
  OBJECTIVE
  To evaluate the prognostic value of testing antiplatelet response in an intermediate-risk population undergoing stent implantation.
  
  
  METHODS
  We prospectively assessed clopidogrel and aspirin response using the VerifyNow assay at the time of coronary stenting in 1001 patients who presented with stable coronary disease or non-ST-segment elevation acute coronary syndrome. The main ischaemic endpoint was the composite of definite and probable stent thrombosis, cardiovascular death or spontaneous myocardial infarction at one year. The safety endpoint was major bleeding.
  
  
  RESULTS
  Overall, 36.0% of patients had high on-clopidogrel platelet reactivity (OCR) and 8.6% had high on-aspirin platelet reactivity (OAR). The main ischaemic composite endpoint occurred in 3.9% of patients with high vs. 2.3% of patients with normal OCR (hazard ratio 1.66, 95% confidence interval 0.78-3.54; P=0.18). Definite or probable stent thrombosis occurred in 1.1% of patients with high vs. 0.3% of patients with normal OCR (P=0.86). There was no significant difference in ischaemic endpoints according to OAR and there was no difference in rates of major bleeding between patients with high versus normal on-treatment platelet reactivity.
  
  
  CONCLUSIONS
  On-treatment platelet reactivity was not associated with 1-year ischaemic or bleeding events in an intermediate-risk population undergoing stent implantation.
authors.affiliation: Department of Cardiology, les hôpitaux de Chartres, Eure-et-Loir, 4, rue Claude-Bernard, 28630 Le Coudray, France. Electronic address: grange@ch-chartres.fr.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Rangé
authors.affiliation: Department of Cardiology, centre hospitalier de la région d'Annecy, Annecy, France.
authors.forename: Komlavi
authors.initials: K
authors.lastname: Yayehd
authors.affiliation: Department of Cardiology, centre hospitalier de la région d'Annecy, Annecy, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.affiliation: Department of Cardiology, les hôpitaux de Chartres, Eure-et-Loir, 4, rue Claude-Bernard, 28630 Le Coudray, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Thuaire
authors.affiliation: Department of Cardiology, clinique Saint-Martin, Caen, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Richard
authors.affiliation: Department of Cardiology, centre hospitalier Lorient, Lorient, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cazaux
authors.affiliation: Department of Cardiology, hôpital d'instruction des armées du Val-de-Grâce, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Barbou
authors.affiliation: Department of Cardiology, clinique Saint-Hilaire, Rouen, France.
authors.forename: René
authors.initials: R
authors.lastname: Köning
authors.affiliation: Department of Cardiology, clinique Saint-Gatien, Tours, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Chassaing
authors.affiliation: Department of Cardiology, hôpital Henri-Mondor, Créteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Department of Cardiology, hôpital de Corbeil, Corbeil, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Berthier
authors.affiliation: Department of Cardiology, clinique de la Reine-Blanche, Orléans, France.
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Decomis
authors.affiliation: Department of Cardiology, infirmerie protestante, Lyon, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Claudel
authors.affiliation: Department of Cardiology, hôpital de Pau, Pau, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delarche
authors.affiliation: Department of Cardiology, nouvelles cliniques nantaises, Nantes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunel
authors.affiliation: Department of Cardiology, hôpital Haguenau, Haguenau, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: De Poli
authors.affiliation: Department of Cardiology, hôpital privé d'Antony, Antony, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dupouy
authors.affiliation: Institut de cardiologie, hôpital la Pitié-Salpêtrière, Paris, France.
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.affiliation: Department of Cardiology, les hôpitaux de Chartres, Eure-et-Loir, 4, rue Claude-Bernard, 28630 Le Coudray, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Albert
authors.affiliation: Institut de cardiologie, hôpital la Pitié-Salpêtrière, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Institut de cardiologie, hôpital la Pitié-Salpêtrière, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Bleeding; Ischaemic events; On-platelet reactivity; Réactivité plaquettaire; Saignements; VerifyNow; VerifyNow assay; Évènements ischémiques