Home > Interventional Cardiology > Journal Club 20 June 2012

Journal Club 20 June 2012

SC presented GRAVITAS and TRIGGER-PCI papers.

GRAVITAS examined the value of the double dose maintenance clopidogrel (150 mg per day) versus standard dose on patient’s with reactive platelets despite clopidogrel as assessed by VerifyNow assay.  TRIGGER-PCI examined  prasugrel versus clopidogrel in stable patients with elevated platelet reactivity (using VerifyNow)  undergoing PCI.

Some  comments:

  • both trials were negative, i.e. the active regimen was not significantly different to standard care
  • the prevalence of high platelet reactivity on clopidogrel is from 20 to 40% depending on definition and assay
  • high platelet reactivity is associated with higher frequency of adverse clinical events
  • double does clopidogrel did not significantly alter platelet function or clinical events
  • prasugrel did significantly reduce platelet reactivity compared with clopidogrel, however, this did not translate into a significantly lower rate of clinical events
  • the TRIGGER-PCI trial was low risk patients, had lower event rates than the power calculations modelled for. It is noted that the outcomes in the trial are directionally consistent with the hypothesis of improved outcome and increased bleeding
  • the role of platelet function testing in intervention remains uncertain, particularly if there is substitution for clopidogrel by ticagrelor/prasugrel  (there being no superior alternative to these). If there is a role, it would relate to a ‘rationing’ or cost effectiveness argument with large price differential in favour of clopidogrel
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