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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\n            \u003Cp id=\u0022p-1\u0022\u003EResponses to oral antiplatelet therapy between patients are variable; thus, bedside assessment has been regarded as an opportunity for individualizing therapy for patients following coronary stent implantation to ensure the optimal platelet inhibition is obtained. The Double Randomization of a Monitoring Adjusted Antiplatelet Treatment Versus a Common Antiplatelet Treatment for DES Implantation and Interruption Versus Continuation of Double Antiplatelet Therapy [ARCTIC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00827411\u0026amp;atom=%2Fspmdc%2F12%2F18%2F23.atom\u0022\u003ENCT00827411\u003C\/a\u003E; Collet JP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] trial evaluated platelet function testing with antiplatelet dose adjustment in suboptimal responders compared with standard of care.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResponses to oral antiplatelet therapy between patients are variable; thus, bedside assessment has been regarded as an opportunity for individualizing therapy for patients following coronary stent implantation to ensure the optimal platelet inhibition is obtained. The Double Randomization of a Monitoring Adjusted Antiplatelet Treatment Versus a Common Antiplatelet Treatment for DES Implantation and Interruption Versus Continuation of Double Antiplatelet Therapy [ARCTIC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00827411\u0026amp;atom=%2Fspmdc%2F12%2F18%2F23.atom\u0022\u003ENCT00827411\u003C\/a\u003E; Collet JP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] trial presented by Gilles Montalescot, MD, PhD, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France, evaluated platelet function testing (PFT) with antiplatelet dose adjustment in suboptimal responders compared with standard of care.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPatients scheduled for planned percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation were randomized to PFT and antiplatelet therapy with dose adjustment for high platelet reactivity (n=1213) versus conventional therapy (n=1227). Patients in both groups then underwent PCI with stent implantation followed by drug and dose adjustment for high platelet reactivity at Day 14 versus conventional therapy. The VerifyNow P2Y12 and aspirin assays were used to estimate the inhibition of platelet aggregation provided by clopidogrel and aspirin. The primary endpoint was death, MI, stroke or transient ischemic attack, stent thrombosis, or urgent revascularization at 12 months. The main secondary endpoints were stent thrombosis or urgent revascularization and major bleeding. The antiplatelet dose adjustment rules used in the study are shown in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E.\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\/12\/18\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Antiplatelet Dose Adjustment Rules.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-581657725\u0022 data-figure-caption=\u0022Antiplatelet Dose Adjustment Rules.\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\/12\/18\/23\/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\/12\/18\/23\/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\/12\/18\/23\/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\/13095\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EAntiplatelet Dose Adjustment Rules.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDES=drug-eluting stent; inh=inhibition; LD=loading dose; MD=maintenance dose; PCI=percutaneous coronary intervention; PRU=platelet reactivity units.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from G Montalescot, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EOf the total 2440 patients, 20% were women, 37% had a history of diabetes mellitus, and 31% had a history of myocardial infarction (MI). In the PFT group, 7.6% of patients were aspirin poor responders and 35% were thienopyridine poor responders. Among the aspirin poor responders, 85% received on-table aspirin loading. Thienopyridine poor responders received on-table clopidogrel loading (80%), on-table prasugrel loading (3.3%), and on-table GP IIb\/IIIa inhibitor loading (80%). Among patients with high on-clopidogrel reactivity at Day 14, 43% had their clopidogrel maintenance increased and 17% were started on prasugrel maintenance dose. Among patients with high on-aspirin reactivity, 46% had their aspirin maintenance dose increased.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt 1 year, the primary endpoint rate was not different between the PFT (34.6%) and conventional therapy groups (31.1%; HR, 1.13; 95% CI, 0.98 to 1.29; p=0.096). The majority of events that comprised the primary endpoint were periprocedural MIs. No significant difference was seen in the 1-year rate of MI between treatment strategy groups (30.3% with PFT-guided therapy vs 28.4% with conventional therapy; HR, 1.08; 95% CI, 0.93 to 1.25; p=0.32), and these neutral findings drove the primary composite results. There also were no significant differences in the rates of the main secondary endpoints (stent thrombosis or urgent revascularization) with PFT-guided therapy compared with conventional therapy (4.9% vs 4.6%; HR, 1.06; 95% CI, 0.74 to 1.52; p=0.77). Data for other ischemic endpoints are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13071\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13071\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13071\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\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EOther Ischemic Endpoints.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EKey safety outcomes were not significantly different with PFT versus conventional therapy: major bleeding (2.3% vs 3.3%; HR, 0.70; 95% CI, 0.43 to 1.14; p=0.15), minor bleeding (1.0% vs 1.7%; HR, 0.57; 95% CI, 0.28 to 1.16; p=0.12), and major or minor bleeding (3.1% vs 4.5%; HR, 0.69; 95% CI, 0.46 to 1.05; p=0.08).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe ARCTIC study results show that PFT with antiplatelet adjustment before and after stenting does not improve clinical outcomes versus conventional treatment without PFT. These results do not support the routine use of PFT in patients undergoing stenting. The ARCTIC-2 study, in which a second randomization was performed at 1 year after the initial randomization to determine the effect of continuation versus interruption of clopidogrel is ongoing. The Tailored Antiplatelet Therapy Versus Recommended Dose of Prasugrel [ANTARCTIC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01538446\u0026amp;atom=%2Fspmdc%2F12%2F18%2F23.atom\u0022\u003ENCT01538446\u003C\/a\u003E] study will evaluate the value of PFT in elderly patients, with a focus on bleeding events. Whether PFT-guided antiplatelet therapy provides benefit for specific types of ischemic events such as spontaneous MI or stent thrombosis is unclear, as the ARCTIC trial was not powered for these individual endpoints and primary findings were largely driven by periprocedural events.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\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\/12\/18\/23.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?nzn6n1\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?nzn6n1\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_tables.js?nzn6n1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}