open access

Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-09
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Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

Lukasz Koltowski, Mariusz Tomaniak, Daniel Aradi, Zenon Huczek, Krzysztof J. Filipiak, Janusz Kochman, Pawel Balsam, Sylwia Gajda, Grzegorz Opolski
DOI: 10.5603/CJ.a2017.0026
·
Pubmed: 28281736
·
Cardiol J 2017;24(3):284-292.

open access

Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-09

Abstract

Background: Dual antiplatelet therapy (DAPT) is recommended after elective percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients; however, still one-third of patients do not obtain adequate platelet inhibition that may result in increased cardiovascular risk. The aim of the ONSIDE TEST study is to evaluate the clinical impact of point-of-care genotyping- and platelet function-based personalized dual antiplatelet strategies in SCAD individuals undergoing PCI.

Methods: Fifty patients were randomized to one of the three study arms: 1) genotyping, 2) platelet function testing (PFT) and 3) control. Patients were tested with point-of-care Spartan RX CYP2C19 System (group 1) and VerifyNow P2Y12 assay (group 2). In cases of inadequate response to clopidogrel, a loading dose of prasugrel was administered before PCI. The main clinical endpoint is the incidence of periprocedural myocardial injury (PMI).

Results: Five (32%) patients in the genotyping arm and two (13%) in the in the PFT arm were identi-fied as poor clopidogrel metabolizers. The periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms as compared to the control arm (176 ± 67.8 PRU), p = 0.01 and p = 0.03, respectively. PMI appeared in 17 (37%) patients of the entire study population.

Conclusions: Personalized DAPT results in an improved platelet inhibition. Apart from genotyping and aggregometry, it is feasible to integrate into everyday clinical practice PMI rates which are relevant when comparing different strategies

Abstract

Background: Dual antiplatelet therapy (DAPT) is recommended after elective percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients; however, still one-third of patients do not obtain adequate platelet inhibition that may result in increased cardiovascular risk. The aim of the ONSIDE TEST study is to evaluate the clinical impact of point-of-care genotyping- and platelet function-based personalized dual antiplatelet strategies in SCAD individuals undergoing PCI.

Methods: Fifty patients were randomized to one of the three study arms: 1) genotyping, 2) platelet function testing (PFT) and 3) control. Patients were tested with point-of-care Spartan RX CYP2C19 System (group 1) and VerifyNow P2Y12 assay (group 2). In cases of inadequate response to clopidogrel, a loading dose of prasugrel was administered before PCI. The main clinical endpoint is the incidence of periprocedural myocardial injury (PMI).

Results: Five (32%) patients in the genotyping arm and two (13%) in the in the PFT arm were identi-fied as poor clopidogrel metabolizers. The periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms as compared to the control arm (176 ± 67.8 PRU), p = 0.01 and p = 0.03, respectively. PMI appeared in 17 (37%) patients of the entire study population.

Conclusions: Personalized DAPT results in an improved platelet inhibition. Apart from genotyping and aggregometry, it is feasible to integrate into everyday clinical practice PMI rates which are relevant when comparing different strategies

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Keywords

platelet aggregation inhibitors, platelet testing, clopidogrel, prasugrel, pharmacotherapy individualization

About this article
Title

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

Journal

Cardiology Journal

Issue

Vol 24, No 3 (2017)

Pages

284-292

Published online

2017-03-09

DOI

10.5603/CJ.a2017.0026

Pubmed

28281736

Bibliographic record

Cardiol J 2017;24(3):284-292.

Keywords

platelet aggregation inhibitors
platelet testing
clopidogrel
prasugrel
pharmacotherapy individualization

Authors

Lukasz Koltowski
Mariusz Tomaniak
Daniel Aradi
Zenon Huczek
Krzysztof J. Filipiak
Janusz Kochman
Pawel Balsam
Sylwia Gajda
Grzegorz Opolski

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