Benefit of switching dual antiplatelet therapy after ACS according to platelet reactivity: A prespecified analysis of the TOPIC randomized study - 05/01/18
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Résumé |
Background |
TOPIC (Timing Of Platelet Inhibition after acute Coronary syndrome) trial showed that switched dual antiplatelet therapy (DAPT) improved net clinical benefit after ACS.
Purpose |
The objective of this analysis was to evaluate the impact of initial platelet reactivity on the benefit of this strategy.
Methods |
Patients admitted with ACS requiring coronary intervention were randomly assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). All patients underwent platelet function testing at this time and were classified according to PRI VASP as low on-treatment platelet reactivity (LTPR=PRI VASP≤20%) or no LTPR (PRI VASP>20%). The primary endpoint of this analysis aimed to evaluate the impact of on-treatment platelet reactivity on clinical outcomes (a composite of ischemic and bleeding events at one year) in both groups.
Results |
Six hundred and forty-five patients were included in the analysis, of whom 305 (47%) were classified as LTPR. LTPR patients were less often diabetic (P=0.01), had lower BMI (P<0.01) and more often on ticagrelor (P<0.01). Patients defined as LTPR and randomized to unchanged DAPT were at highest risk of primary endpoint occurrence at 1 year (31%, P<0.01). At one year, switching strategy was associated with reduction in primary endpoint incidence in LTPR patients (HR 95% CI 0.34 (0.21–0.54), P<0.01) (Fig. 1), and numerically lower incidence in non-LTPR (HR 95% CI 0.71 (0.43–1.18), P=0.19). In switching arm, LTPR patients had no significant difference in primary outcome incidence in comparison with no LTPR (HR 95% CI 0.79 (0.44–1.44), P=0.44) (Fig. 1).
Conclusion |
Switching DAPT strategy was superior regardless of initial platelet reactivity. Interestingly, the switching strategy was highly efficient in hyper responders, who had impaired prognosis with unchanged DAPT but similar prognosis after switching.
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Vol 10 - N° 1
P. 19-20 - janvier 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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