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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe TRIAGE study was conducted to determine whether platelet reactivity testing added to clinical assessment of patients treated with prasugrel vs clopidogrel would better identify patients at high ischemic risk. However, low enrollment resulted in a sample size too small to detect a between-group difference; none was found for any of the prespecified efficacy or safety outcomes.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eclopidogrel\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehigh on-treatment platelet reactivity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHTPR\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemic risk\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elow on-treatment platelet reactivity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELTPR\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprasugrel\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETRIAGE\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EJaya Chandrasekhar, MBBS, Icahn School of Medicine at Mount Sinai, New York, New York, USA, presented results of the TRIAGE study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01582217\u0026amp;atom=%2Fspmdc%2F15%2F10%2F9.atom\u0022\u003ENCT01582217\u003C\/a\u003E], demonstrating that patients with high on-treatment platelet reactivity (HTPR) receiving prasugrel and patients with low on-treatment platelet reactivity (LTPR) treated with clopidogrel had similar ischemic and bleeding outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHTPR in patients treated with clopidogrel is associated with a greater incidence of adverse cardiac events such as stent thrombosis, myocardial infarction (MI), and even death. However, testing platelet function prior to thienopyridine selection in patients undergoing percutaneous coronary intervention (PCI) has not been shown to correlate with improved outcomes in recent randomized trials, and the role of screening for platelet function in the context of ischemic and bleeding risks has not been investigated.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETRIAGE was a multicenter, prospective, observational study. The objective was to compare outcomes in patients treated with prasugrel vs clopidogrel at PCI following determination of platelet reactivity in conjunction with clinical risks. The primary safety and efficacy end points were the rate of major adverse cardiac events (MACE) and the rate of BARC type 2, 3, or 5 bleeding, respectively, at 1-year follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPlatelet reactivity was tested immediately prior to PCI, and HTPR was defined as P2Y12 Reaction Units (PRU) \u2265\u2005230. Patients were further split into treatment groups based on their ischemic and bleeding risk levels (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). High ischemic risk was defined as undergoing PCI for acute coronary syndromes or stent thrombosis, high angiographic risk PCI, or 30-day stent thrombosis score of \u2265\u20056. High bleeding risk was defined as having a bleeding risk score \u2265\u200510, recent surgery, recent bleeding history, or bleeding diathesis.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/9\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022TRIAGE Study AlgorithmHTPR, high on-treatment platelet reactivity; LTPR, low on-treatment platelet reactivity; PCI, percutaneous coronary intervention; PRU, P2Y12 Reaction Units; TIA, transient ischemic attack.Reproduced with permission from J Chandrasekhar, MBBS.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1380535889\u0022 data-figure-caption=\u0022TRIAGE Study AlgorithmHTPR, high on-treatment platelet reactivity; LTPR, low on-treatment platelet reactivity; PCI, percutaneous coronary intervention; PRU, P2Y12 Reaction Units; TIA, transient ischemic attack.Reproduced with permission from J Chandrasekhar, MBBS.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/9\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/9\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/10\/9\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16676\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ETRIAGE Study Algorithm\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EHTPR, high on-treatment platelet reactivity; LTPR, low on-treatment platelet reactivity; PCI, percutaneous coronary intervention; PRU, P2Y12 Reaction Units; TIA, transient ischemic attack.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EReproduced with permission from J Chandrasekhar, MBBS.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThe anticipated study sample size was 1000 patients, but recruitment was terminated due to slow enrollment at 318 patients (mean age, 65.9 years; 19.0% women). Based on the study criteria, 40% of patients were classified to be at high ischemic risk, 58% with PRU \u2265\u2005230 and\/or high ischemic risk, and 34% at high bleeding risk. Clopidogrel was continued in 72% of patients, whereas 28% received prasugrel.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe primary efficacy end point did not differ significantly between treatment groups: MACE (death, nonfatal MI, or stent thrombosis) occurred in 3.5% of patients on clopidogrel and 4.4% on prasugrel (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.70). The rate of secondary ischemic end points including periprocedural MI was also similar between the treatment groups with nonsignificant \u003Cem\u003EP\u003C\/em\u003E values. The primary safety end point occurred in 7.9% of patients on clopidogrel and 5.6% on prasugrel (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.47). The secondary bleeding end points were also nonsignificant, with patients on clopidogrel experiencing a numerically but not statistically higher rate of bleeding events.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EMACE and secondary ischemic end points occurred at a similar rate in patients with PRU \u0026lt;\u2005230 and those with PRU \u2265\u2005230. Analogously, when patients with PRU \u0026lt;\u2005208 were compared with those with PRU \u2265\u2005208, ischemic end points were numerically but nonsignificantly different (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.08).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIn conclusion, the TRIAGE study did not find a significant difference between groups for any of the prespecified efficacy or safety end points. The low enrollment resulted in a sample size that was too small to detect any significant differences between groups. Other study limitations were the unblinded treatment, low event rate, and use of an unvalidated treatment algorithm, although it incorporated validated ischemic and bleeding score components. The difference in the number of ischemic and bleeding events between groups may suggest that platelet function testing may identify more patients at a high ischemic risk than clinical assessment alone, but this must be tested in a larger study.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/10\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzll8d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzll8d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}