Clinical risk factor assessment combined with platelet function test results may help interventional cardiologists better determine high-risk patients that would benefit from intensive antiplatelet medication after percutaneous coronary intervention (PCI), results of the TRIAGE study have shown. This late-breaking clinical trial was presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2015 Scientific Sessions.
New platelet function tests have been developed recently but its use alone has not shown to be advantageous in randomized trials. In this study, researchers created an algorithm combining risk factors (eg, PCI indication, high angiographic risk PCI, high ischemic or bleeding risk scores) with platelet function test results to determine high on treatment platelet reactivity (HTPR) or patients likely to still have highly reactive platelets even after taking antiplatelet agents. Patients’ platelet function was tested immediately before PCI via the VerifyNow assay.
Suitable patients whose assessment indicated HTPR received antiplatelet drug prasugrel, while patients with low on treatment platelet reactivity (LTPR) received clopidogrel. Compared to clopidogrel, prasugrel has been shown to reduce the risk of adverse events in heart disease patients undergoing PCI, but is associated with increased bleeding.
Of the 318 total patients assessed, 228 received clopidogrel following PCI, and 90 received prasugrel. After one year, HTPR patients who received prasugrel showed similar rates of major adverse cardiovascular events (MACE, including death, spontaneous heart attack or blood clot in the stent) vs. patients receiving clopidogrel (4.4% vs. 3.5%; P=0.7). No significant differences were found in death (4.4% vs. 1.8%), blood clot (0% vs. 0.4%), spontaneous heart attack (1.1% vs. 2.2%) or need for repeat stenting in the treated artery (6.7% vs. 7.0%) between the two patient groups (P>0.5).
Findings from the study support that the clinical risk algorithm may be effective in identifying which patients may benefit from using prasugrel vs. continuing on clopidogrel following PCI. Researchers call for more trials with better patient numbers to demonstrate a definitive long-term reduction in adverse events with this approach.
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