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Bedside Monitoring to Adjust Antiplatelet Therapy for Coronary Stenting
Open accessAbstract
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.).
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“Moreover, large, superiority RCTs have failed to show a higher efficacy of routine platelet-function testing in guiding antiplatelet therapy post-PCI.322,322a”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [322]
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“Current evidence does not support platelet function testing to adjust DAPT.”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [322]
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“Despite initial enthusiasm, multiple large, randomized studies have failed to show any clinical benefit when antithrombotic regimens are adjusted on the basis of platelet function testing.60–62”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [62]
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Metadata
- Authors
- Collet, J.-P., Cuisset, T., Rangé, G., Cayla, G., Elhadad, S., Pouillot, C., Henry, P., Motreff, P., Carrié, D., Boueri, Z., Belle, L., Van Belle, E., Rousseau, H., Aubry, P., Monségu, J., Sabouret, P., O'Connor, S. A., Abtan, J., Kerneis, M., Saint-Etienne, C., Barthélémy, O., Beygui, F., Silvain, J., Vicaut, E., & Montalescot, G.
- Affiliations
- Pitié-Salpêtrière Hospital (FR)
- Hôpital de la Timone (FR)
- Les Hôpitaux de Chartres (FR)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Hôpital Lariboisière (FR)
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Hôpital Rangueil (FR)
- Hôpital Bichat-Claude-Bernard (FR)
- HIA du Val-de-Grâce à Paris (FR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-11-29
- Volume
- 367
- Issue
- 22
- Pages
- 2100-2109
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2145323902
- Cited by
- 887
- References
- 26
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 22 · 2023: 31 · 2022: 31 · 2021: 47 · 2020: 44 · 2019: 52 · 2018: 72 · 2017: 77 · 2016: 80 · 2015: 123 · 2014: 122 · 2013: 141 · 2012: 8
- FWCI
- 81.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- antiplatelet therapy, coronary stenting, platelet function monitoring, VerifyNow P2Y12 assay, clopidogrel, prasugrel, aspirin, stent thrombosis, bleeding events, glycoprotein IIb/IIIa inhibitors, individualized dosing, major adverse cardiovascular events
- MeSH terms
- Prasugrel Hydrochloride, Clopidogrel, Aged, Aspirin, Coronary Disease, Coronary Thrombosis, Female, Humans, Male, Middle Aged, Myocardial Infarction, Piperazines, Platelet Aggregation Inhibitors, Pyridines, Thiophenes, Ticlopidine, Stents, Drug Monitoring, Point-of-Care Systems, Retreatment
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