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Why have studies of tailored anti-platelet therapy failed so far?

Jolanta M Siller-Matula1, Bernd Jilma

  • 1Jolanta Siller-Matula, MD, PhD, Department of Cardiology, Medical University of Vienna, Vienna, Austria, Tel.: +43 1 40 400 4614, Fax: +43 1 40 400 4216,

Thrombosis and Haemostasis
|July 26, 2013
PubMed

Insights

Monitoring clopidogrel therapy by measuring platelet inhibition did not reduce cardiac events in clinical trials. Despite lowering platelet reactivity, this individualized approach showed no benefit for patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Published data suggests a link between clopidogrel non-responsiveness and adverse ischemic events.
  • This led to the hypothesis that monitoring and adjusting clopidogrel's platelet inhibition could improve patient outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of adjusting clopidogrel therapy based on platelet function monitoring in reducing cardiac ischemic events.

Main Methods:

  • Analysis of randomized clinical trials including ARCTIC, GRAVITAS, and TRIGGER-PCI.
  • Assessment of strategies involving therapy adjustment guided by platelet function monitoring.

Main Results:

  • While platelet reactivity was reduced, the strategy of adjusting clopidogrel therapy did not decrease the incidence of cardiac ischemic events.
  • The trials did not demonstrate a clinical benefit from individualized antiplatelet therapy based on platelet function tests.

Conclusions:

  • Despite reducing platelet reactivity, therapy adjustment based on platelet function monitoring did not reduce cardiac ischemic events in the studied trials.
  • Critical issues in trial design may have contributed to the negative results and warrant further discussion.

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