Given the individual variability of response to antiplatelet therapies, measuring platelet function and designing tailored therapies could be beneficial.
The ARTIC study tested the superiority of bedside platelet function monitoring with drug adjustment vs. the conventional post DES therapy without monitoring and drug adjustment. It included 2466 patients with stable coronary disease or Non-ST Elevation AMI. Platelet function was tested before angioplasty (PCI) and again 2-4 weeks later.
On the basis of identified resistance, high platelet reactivity to aspirin (AAS) led to the administration of an additional 500 mg bolus before PCI. After two weeks, when reactivity persisted, maintenance dose was doubled. High platelet reactivity to clopidogrel led to an additional loading 600 mg dose, or IIbIIIa glycoprotein inhibitors, or prasugrel administration. When resistant after two weeks, dose was doubled or switched to prasugrel.
Primary end point was a composite of death, infarction, stent thrombosis, urgent revascularization and stroke. After a year follow up, no differences were observed in the composite end point or in each individual component when comparing adjusted therapy vs. standard therapy (34,6% vs. 31,1% p=0,096 respectively). Bleeding events did not differ significantly between the two groups (3,1% vs 4,5% p=0,08 respectively).
Conclusion: According to the ARTIC trial, there is not enough evidence to support bedside platelet function monitoring.
Comment: though physiologically interesting, bedside platelet function monitoring has not shown clinical benefits in this trial, or in previous ones. Clopidogrel reactivity as a risk factor and event predictor seems not to be adjustable.
Gilles Montalescot
2012-11-04
Original title: A Randomized Trial of Bedside Platelet Function Monitoring to Adjust Antiplatelet Therapy Versus Standard of Care in Patients Undergoing Drug Eluting Stent Implantation. The Artic Study.
