Cited by 887Antiplatelet Therapy and Cardiovascular DiseasesCoronary Interventions and DiagnosticsAcute Myocardial Infarction Research

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Bedside Monitoring to Adjust Antiplatelet Therapy for Coronary Stenting

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Collet, Jean-Philippe, Cuisset, Thomas, Rangé, Grégoire, Cayla, Guillaume, Elhadad, Simon, Pouillot, Christophe, Henry, Patrick, Motreff, Pascal, Carrié, Didier, Boueri, Ziad, Belle, Loic, Van Belle, Eric, Rousseau, Hélène, Aubry, Pierre, Monségu, Jacques, Sabouret, Pierre, O'Connor, Stephen A., Abtan, Jérémie, Kerneis, Mathieu, Saint-Etienne, Christophe, Barthélémy, Olivier, Beygui, Farzin, Silvain, Johanne, Vicaut, Eric, Montalescot, Gilles·2012·New England Journal of Medicine

DOI 10.1056/nejmoa1209979

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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.).

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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: Collet, Jean-Philippe
Cuisset, Thomas
Rangé, Grégoire
Cayla, Guillaume
Elhadad, Simon
Pouillot, Christophe
Henry, Patrick
Motreff, Pascal
Carrié, Didier
Rousseau, Hélène
Aubry, Pierre
Sabouret, Pierre
Abtan, Jérémie
Barthélémy, Olivier
Beygui, Farzin
Silvain, Johanne
Montalescot, Gilles
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
DOI: 10.1056/nejmoa1209979
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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