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Platelet Reactivity over Time and Clinical Outcomes in Medically Managed ACS

Summary and Comment |
November 4, 2012

Platelet Reactivity over Time and Clinical Outcomes in Medically Managed ACS

  1. Beat J. Meyer, MD

In a substudy of TRILOGY acute coronary syndromes, the VerifyNow device detected no useful associations.

  1. Beat J. Meyer, MD

In the TRILOGY ACS trial, no association was found between platelet reactivity and clinical outcomes in patients with acute coronary syndromes without ST-segment elevation initially treated medically (JW Cardiol Aug 26 2012). In a prespecified substudy, 27.5% of the 9326 TRILOGY ACS participants randomized to prasugrel (age <75 and weight ≥60 kg, 10 mg/day; age ≥75 or weight <60 kg, 5 mg/day) or clopidogrel (75 mg/day) underwent platelet-reactivity testing at baseline, 2 hours after randomization, and at 1, 3, 6, 12, 18, 24, and 30 months of study drug treatment. Platelet inhibition was measured in P2Y12 reaction units (PRUs) with the VerifyNow device.

At 30 days, median PRU values were significantly lower in the prasugrel group than in the clopidogrel group (P<0.001); this difference persisted throughout follow-up and was present regardless of age or weight. At 30 months, the rate of the primary efficacy endpoint was 17.2% in the prasugrel group and 18.9% in the clopidogrel group (P=0.29). Continuous distribution of 30-day PRU values also did not differ significantly between participants who experienced a primary endpoint after 30 days and those who did not (P=0.07).

Comment

In this large, embedded study with long-term serial platelet-reactivity comparisons, prasugrel was associated with sustained reductions in platelet reactivity compared with clopidogrel in patients who did not undergo revascularization for acute coronary syndromes. However, the VerifyNow platelet function device was unable to discriminate between patients with and without subsequent ischemic events. The device is therefore of no use in clinical practice.

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