title: Dual antiplatelet therapy tailored on platelet function test after coronary stent implantation: a real-world experience.
abstract: Patients' response to dual antiplatelet therapy (DAPT) is subject to variations and its monitoring allows to individualize this therapy. In this study, we evaluated if a strategy of tailored DAPT after platelet function testing could reduce high on-treatment platelet reactivity (HPR) and improve outcome of patients treated with stent implantation. In 257 patients undergoing percutaneous angioplasty, platelet function was measured by light transmittance aggregometry (LTA) using 10 µM/L adenosine-diphosphate (ADP) and 1 mM arachidonic acid (AA) as agonists. Patients with HPR by ADP (≥70%) were switched to double-dose clopidogrel, ticlopidine, prasugrel or ticagrelor; in patients with HPR by AA (≥20%) acetylsalicylic acid dose was increased if not contraindicated. Platelet function analysis was repeated 48 hours after therapy variation. At 20-month follow-up major adverse cardiovascular events (MACE) and bleedings were assessed. HPR was detected in 97/257 (37.7%) patients: 69/257 (26.8%) had HPR by ADP and 71/257 (27.6%) had HPR by AA. In patients with HPR by ADP or by AA, tailored DAPT determined a significant reduction in residual platelet reactivity. No significant difference in MACE or bleeding occurrence was documented in HPR patients treated with tailored DAPT vs. those without HPR. HPR patients treated with tailored DAPT had significant lower follow-up MACE and deaths vs. 139 HPR patients not switched, even after propensity score analysis. These results suggest that a DAPT tailored on platelet testing can improve antiplatelet response in HPR patients, possibly reducing their thrombotic events to a level similar to non-HPR patients, without increasing the risk of bleeding.
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. emanuelececchi@virgilio.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cecchi
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.|Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.|Centre for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases To Develop Novel Therapies, University of Florence, Florence, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Marcucci
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Mecarocci
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Spini
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Innocenti
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Calabretta
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cordisco
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: Romano
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.|Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.|Centre for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases To Develop Novel Therapies, University of Florence, Florence, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.|Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.|Centre for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases To Develop Novel Therapies, University of Florence, Florence, Italy.|Centro S. Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Impruneta, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D004359:Drug Therapy, Combination / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D015607:Stents / Q000009:adverse effects* / Q000639:trends; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Dual antiplatelet therapy; Percutaneous coronary intervention; Shifting therapy