Platelet function testing in atrial fibrillation patients undergoing percutaneous coronary intervention

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Non-valvular atrial fibrillation undergoing percutaneous coronary intervention (n=101). Intervention: Ticagrelor vs. Clopidogrel. Primary outcome: Platelet reactivity (PRU) (MD 116.88, 95% CI 94.05-139.71, p=<0.001).

Ioannis Lianos; Charalampos Varlamos; Despoina-Rafailia Benetou; Christos Mantis; Konstantinos Kintis; Vassiliki-Maria Dragona; John Kanakakis; Dimitrios Sionis; Sotirios Patsilinakos; Dimitrios Alexopoulos

doi:10.1007/s11239-022-02723-4

November 12, 2022Journal of Thrombosis and ThrombolysisOpen Access

Platelet function testing in atrial fibrillation patients undergoing percutaneous coronary intervention

View Full Paper

Ask AI

Bookmark

Share

Key result

Ticagrelor administration in atrial fibrillation patients on oral anticoagulants undergoing PCI resulted in significantly lower platelet reactivity compared to clopidogrel (mean difference 116.88 PRU).

Figures

Why the study?

Platelet function testing could be useful to guide individualized antithrombotic treatment in AF patients undergoing PCI, prompting an investigation of platelet reactivity in a contemporary registry.

Does ticagrelor compared to clopidogrel improve platelet reactivity in patients with atrial fibrillation on oral anticoagulants undergoing PCI?

Study Design

Type

Observational (n=101)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does ticagrelor compared to clopidogrel improve platelet reactivity in patients with atrial fibrillation on oral anticoagulants undergoing PCI?

P

Population

101 patients (mean age 70.8 years, 19.8% female) with non-valvular atrial fibrillation on oral anticoagulants undergoing percutaneous coronary intervention, followed for 12 months.

E

Exposure

Ticagrelor as part of double or triple antithrombotic therapy with platelet function testing before discharge

C

Comparator

Clopidogrel as part of double or triple antithrombotic therapy with platelet function testing before discharge

O

Outcome

Platelet reactivity (PR) measured in platelet reaction units (PRU) and incidence of high on-treatment platelet reactivity (HTPR) and low on-treatment platelet reactivity (LTPR)surrogate

Main Result

Mean Difference: 116.88 (95% CI 94.05–139.71)

Absolute Event Rate: 46.03% vs 162.91%

p-value: p=<0.001

Limitations

Nonrandomized, registry data with lack of statistical adjustments
Small sample size rendering the study underpowered for clinical events
Premature discontinuation of the PFT sub-study due to completion of the main study
Apixaban was underrepresented in the study population
Nonrandomized, registry data with lack of statistical adjustments for differences in compared group characteristics
Small sample size renders the study underpowered for clinical events and hinders propensity score matching
Premature discontinuation due to completion of the main study and slower recruitment in sub-study
Apixaban was underrepresented
Edoxaban was not available and prasugrel use was limited

Implication

In AF patients on oral anticoagulants undergoing PCI, ticagrelor provides more potent platelet inhibition than clopidogrel, but platelet function testing had variable impact on clinical decision-making and did not predict bleeding events.

Abstract

Platelet function testing (PFT) could be a useful clinical tool to guide individualized antithrombotic treatment in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We aimed to investigate platelet reactivity (PR) in the context of a contemporary registry. “Real-world” data were retrieved from a nationwide, multicenter, observational study of AF patients on oral anticoagulants (OAC) undergoing PCI. Patients treated with a P2Y 12 inhibitor, namely clopidogrel or ticagrelor, as part of double or triple antithrombotic therapy, were submitted to PFT before discharge and were followed up for 12 months. Out of 101 patients included in the study, 66 were submitted to PFT while on clopidogrel and 35 while on ticagrelor; PR was 162.9 ± 68 PRU and 46.02 ± 46 PRU, respectively (P < 0.001). High on-treatment PR (HTPR) was observed in 15 patients under clopidogrel (22.7%); 7 of them escalated to ticagrelor. Low on-treatment PR (LTPR) was found in 9 clopidogrel and 28 ticagrelor-treated patients (13.6% vs. 80%, P < 0.001), of whom only 1 de-escalated to clopidogrel. PR did not differ by OAC regimen. PFT results had no impact on aspirin prescription at discharge, while failed to predict significant bleeding events at follow up. Ticagrelor administration led to lower PR and lower incidence of HTPR in comparison with clopidogrel. Physicians’ behavior in response to knowledge of a patient’s PR was variable. Further studies are required to elucidate the role of PFT as a tool to guide individualized antithrombotic treatment in this clinical scenario.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Lianos et al. (2022) conducted an observational in Non-valvular atrial fibrillation undergoing percutaneous coronary intervention (n=101). Ticagrelor vs. Clopidogrel was evaluated on Platelet reactivity (PRU) (MD 116.88, 95% CI 94.05-139.71, p=<0.001). Ticagrelor administration in atrial fibrillation patients on oral anticoagulants undergoing PCI resulted in significantly lower platelet reactivity compared to clopidogrel (mean difference 116.88 PRU).

synapsesocial.com/papers/6a7b7e744c448619ca0e826f https://doi.org/10.1007/s11239-022-02723-4