Table 4.
Clinical trials evaluating personalized antiplatelet therapy based exclusively on platelet function testing.
| Study | Number of patients | Studied population | Antiplatelet therapy | Platelet function test | Outcome |
|---|---|---|---|---|---|
| ANTARCTIC (176) | 877 | Post-PCI in ACS patients (≥75 years old) | ASA+prasugrel (5 mg) | VerifyNowTM | No improvement in clinical outcome |
| LTPR: ASA+clopidogrel (75 mg) | |||||
| HTPR: ASA+prasugrel (10 mg) | |||||
| Aradi et al. (173) | 741 | Post-PCI in high risk ACS patients | ASA+clopidogrel (75 mg) | Multiplate® | Unlike high-dose clopidogrel, switching to prasugrel reduces ischemic risk in HTPR patients |
| HTPR: ASA+prasugrel (10 mg) or ASA+clopidogrel (150 mg or additional 600 mg LD+75 mg) | |||||
| ARCTIC (179) | 1,227 (control) | Post-PCI in CAD/ACS patients | Control: treatment choice left to physician's discretion | VerifyNowTM | No improvement in clinical outcome in the guided-therapy group |
| 1,213 (guided) | HTPR: ASA+prasugrel (10 mg) or ASA+clopidogrel (150 mg) | ||||
| LTPR: ASA+clopidogrel (75 mg) | |||||
| GRAVITAS (178) | 2,214 | Post-PCI in CAD/NSTE-ACS patients | ASA+clopidogrel (75 mg) | VerifyNowTM | No reduction of the incidence of death or cardiovascular events |
| HTPR: ASA+clopidogrel (150 mg) | |||||
| ISAR-HPR (172) | 428 (control) | Post-PCI in CAD/ACS patients | Control: ASA+clopidogrel (75 mg) | Multiplate® | Significant reduction of the incidence of death from any cause in the guided-therapy group |
| 571 (guided) | Guided: ASA+clopidogrel (75 mg) vs. ASA+clopidogrel (additional 600 mg LD+75 mg) or ASA+prasugrel (10 mg) if HPR | ||||
| MADONNA (171) | 395 (control) | Post-PCI in STEMI and NSTE-ACS patients | Control: ASA+clopidogrel (75 mg) | Multiplate® | Reduction of the incidence of stent thrombosis and ACS in the guided-therapy group but no difference in cardiac death or bleeding |
| 403 (guided) | Guided: ASA+clopidogrel (75 mg) vs. ASA+clopidogrel (additional 600 mg LD + 75 mg) or ASA+prasugrel (60 mg LD + 10 mg) if HTPR | ||||
| TRIGGER-PCI (177) | 236 | Post-PCI in CAD HPR patients | ASA+clopidogrel (75 mg) vs. ASA+prasugrel (10 mg) | VerifyNowTM | Switching from clopidogrel to prasugrel afforded effective platelet inhibition. |
| Study stopped prematurely for futility (lower than expected incidence of adverse ischemic events) | |||||
| TROPICAL-ACS (174) | 1,306 (control) | Post-PCI in ACS patients | Control: ASA+prasugrel (10 mg) | Multiplate® | Non-inferiority of guided therapy in terms of cardiovascular death, myocardial infarction, stroke or bleeding complications |
| 1,304 (guided) | Guided: ASA+clopidogrel (75 mg) vs. ASA+prasugrel (10 mg) if HTPR |
ACS, acute coronary syndrome; CAD, stable coronary artery disease; DES, drug-eluting stent; HTPR, high on-treatment platelet reactivity; LD, loading dose; LTPR, low on-treatment platelet reactivity; NSTE, non-ST elevation; PCI, percutaneous coronary intervention, PFT, platelet function testing; STEMI, non-ST elevation myocardial infarction.