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Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial
- Source :
- Journal of Thrombosis and Thrombolysis
- Publication Year :
- 2019
-
Abstract
- To investigate the safety and efficacy of an early platelet function testing (PFT)-guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVS). Early DAPT de-escalation is a new non-inferior alternative to 12-months DAPT in patients with biomarker positive ACS treated with stent implantation. In this post-hoc analysis of the TROPICAL-ACS trial, which randomized 2610 ACS patients to a PFT-guided DAPT de-escalation (switch from prasugrel to clopidogrel) or to control group (uniform prasugrel), we compared clinical outcomes of patients (n = 151) who received a BVS during the index PCI. The frequency of the primary endpoint (cardiovascular death, myocardial infarction, stroke or BARC ≥ 2 bleeding) was 8.8% (n = 6) in the de-escalation group vs. 12.0% (n = 10) in the control group (HR 0.72, 95% CI 0.26-1.98, p = 0.52) at 12 months. One early definite stent thrombosis (ST) occurred in the control group (day 19) and 1 possible ST (sudden cardiovascular death) in the de-escalation group (day 86), both despite prasugrel treatment and in a background of high on-treatment platelet reactivity assessed at day 14 after randomization (ADP-induced platelet aggregation values of 108 U and 59 U, respectively). A PFT-guided DAPT de-escalation strategy could potentially be a safe and effective strategy in ACS patients with BVS implantation but the level of platelet inhibition may be of particular importance. This hypothesis-generating post-hoc analysis requires verification in larger studies with upcoming BVS platforms. peerReviewed
- Subjects :
- Male
Prasugrel
medicine.medical_treatment
030204 cardiovascular system & hematology
0302 clinical medicine
Absorbable Implants
Clinical endpoint
Medicine
030212 general & internal medicine
Myocardial infarction
Stroke
Aged, 80 and over
Platelet function testing
Tissue Scaffolds
Drug Substitution
Hematology
Middle Aged
Clopidogrel
3. Good health
Bioresorbable vascular scaffold
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.drug
Adult
medicine.medical_specialty
Acute coronary syndrome
Adolescent
Platelet Function Tests
Hemorrhage
Article
Blood Vessel Prosthesis Implantation
Young Adult
03 medical and health sciences
Percutaneous Coronary Intervention
Internal medicine
Humans
Acute Coronary Syndrome
Aged
business.industry
Percutaneous coronary intervention
Thrombosis
medicine.disease
Conventional PCI
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Journal of Thrombosis and Thrombolysis
- Accession number :
- edsair.doi.dedup.....7e69ce92c3344f2a7d3c6643e64ddc7e