Intensified antiplatelet therapy in patients after percutaneous coronary intervention with high on-treatment platelet reactivity: the OPTImal Management of Antithrombotic Agents (OPTIMA)-2 Trial.

Abstract

High on-treatment platelet reactivity (HOPR) is associated with increased risk of cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). We randomised post-PCI patients with HOPR after 5 days of standard dual antiplatelet therapy (DAPT) to intensified therapy with aspirin 100 mg once daily in combination with either clopidogrel 150 mg once daily, clopidogrel 75 mg once daily plus cilostazol 100 mg twice daily, ticagrelor 90 mg twice daily, or standard therapy with clopidogrel 75 mg once daily (STD) for 1 month, after which all patients were switched to standard DAPT for a further 11 months. The primary outcome was residual HOPR rate at 1 month. We screened 1724 patients with light transmission aggregation studies and randomised 434 with HOPR. At 1 month the proportion of patients with persistent HOPR was significantly lower in the intensified therapy groups compared with STD group. Compared to the group receiving STD therapy, those receiving intensified therapy had significantly lower rate of major adverse cardiovascular events (MACE) at both 1 month and 12 months with no significant increase in bleeding. In patients with post-PCI HOPR, 1 month of intensified antiplatelet therapy provides greater platelet inhibition and improves outcomes without increasing bleeding. Clinical Trial Registration URL: http://www.clinicaltrials.gov; Unique Identifier: NCT01955200.

• Authors: Lianghong Ying, Jing Wang, Juan Li, Jianzhen Teng, Xiaofeng Zhang, Inam Ullah, Abdus Samee, Ke Xu, Jun Chen, Lei Xu, Hui Zhu, Jimin Li, Lu Yang, Fei Wang, Yuansheng Fan, Jing Zhang, Yi Lu, Xiaoxuan Gong, Lu Shi, John W Eikelboom, Chunjian Li
• Journal: British journal of haematology (Br J Haematol) Vol. 196 Issue 2 Pg. 424-432 (01 2022) ISSN: 1365-2141 [Electronic] England
• PMID: 34611892 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 British Society for Haematology and John Wiley & Sons Ltd.

Chemical References

• Fibrinolytic Agents
• Platelet Aggregation Inhibitors
• Clopidogrel
• Aspirin

Topics

• Aged
• Aspirin (administration & dosage, adverse effects, therapeutic use)
• Blood Coagulation (drug effects)
• Clinical Decision-Making
• Clopidogrel (administration & dosage, adverse effects, therapeutic use)
• Comorbidity
• Disease Management
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects, therapeutic use)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Activation (drug effects)
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Postoperative Care
• Treatment Outcome