Tailored P2Y12 inhibitor treatment in patients undergoing non-urgent PCI—the POPular Risk Score study
Janssen, Paul W.A.; Bergmeijer, Thomas O.; Vos, Gert Jan A.; Kelder, Johannes C.; Qaderdan, Khalid; Godschalk, Thea C.; Breet, Nicoline J.; Deneer, Vera H.M.; Hackeng, Christian M.; ten Berg, Jurriën M.
(2019) European Journal of Clinical Pharmacology, volume 75, issue 9, pp. 1201 - 1210
(Article)
Abstract
PURPOSE: The POPular Risk Score was developed for the selective intensification of P2Y 12 inhibitor treatment with prasugrel instead of clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI) with stent implantation. This score is based on platelet reactivity (VerifyNow P2Y 12 assay), CYP2C19 genotyping, and clinical risk factors. Our
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aim was to determine if the use of this score in clinical practice is associated with a reduction in thrombotic events without increasing bleeding events. METHODS: In a single-center prospective cohort study, patients with a high risk score were treated with prasugrel and patients with a low risk score with clopidogrel. The risk score-guided cohort was compared with a historic cohort of clopidogrel-treated patients. The endpoint consisted of all-cause death, myocardial infarction, stroke, or stent thrombosis during 1 year of follow-up. TIMI major and minor bleeding events were also analyzed. RESULTS: The guided cohort contained 1127 patients, 26.9% of whom were switched to prasugrel according to the POPular Risk Score. The historic cohort contained 893 patients. The incidence of the combined thrombotic endpoint was significantly lower in the guided cohort as compared with the historic cohort (8.4% versus 3.7%, p < 0.001). This strategy was safe with respect to bleeding (4.0% versus 1.3%, p < 0.001, for TIMI major or minor bleeding). Results were comparable after multivariate and propensity score matched and weighted analysis. CONCLUSION: Selective intensification of P2Y 12 inhibitor treatment after non-urgent PCI based on the POPular Risk Score is associated with a reduction in thrombotic events without an increase in bleeding events.
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Keywords: Clopidogrel, CYP2C19, P2Y inhibitor, Percutaneous coronary intervention, Platelet aggregation, Prasugrel, Thrombosis/prevention & control, Humans, Middle Aged, Genotype, Male, Risk, Purinergic P2Y Receptor Antagonists/adverse effects, Hemorrhage/chemically induced, Stroke/prevention & control, Clopidogrel/adverse effects, Platelet Function Tests, Prasugrel Hydrochloride/adverse effects, Cytochrome P-450 CYP2C19/genetics, Female, Aged, Myocardial Infarction/prevention & control, Percutaneous Coronary Intervention, Pharmacology (medical), Pharmacology, Journal Article
ISSN: 0031-6970
Publisher: Springer Verlag
Note: Funding Information: The authors would like to thank all personnel of the St. Antonius Hospital and the referring hospitals involved in this project. Funding Information: Funding This study was supported by the St. Antonius Innovation fund and a ZonMw TopZorg grant. ZonMw is a Dutch organization funded by the government promoting health care research and the implementation of study results in daily practice. The authors were solely responsible for the design and conduct of this study, all study analyses, and the drafting and editing of the paper and its final contents. Publisher Copyright: © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
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