30-day results of ADAPT-DES registry reported at TCT 2011

November 09, 2011

SAN FRANCISCO, CA - NOVEMBER 9, 2011 - The relationship of platelet responsiveness to antiplatelet medications; and, the correlation of poor response, and overall platelet aggregation while on dual antiplatelet therapy to the risk of drug-eluting stent thrombosis after 30 days was examined in ADAPT-DES, the largest registry to date to fully examine these relationships.

Results of ADAPT-DES (Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents) were presented today at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation.

While prior studies have emphasized the absolute level of platelet activation/aggregation to antiplatelet medications, the role of the baseline level of platelet activation and the percentage of platelet inhibition in response to these therapies have largely been unstudied prior to ADAPT-DES.

In addition, the impact of poor platelet response to aspirin, and overall platelet aggregation while on dual antiplatelet therapy (DAPT) on the risk of stent thrombosis has not been fully examined.

In the registry, 8,575 patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents were enrolled at 11 sites between January 2008 and September 2010. The researchers assessed platelet reactivity to aspirin and clopidogrel as well as overall platelet responsiveness with the VerifyNow Aspirin, P2Y12, and IIb//IIIa tests after successful implantation of drug-eluting stents. Definite or probable stent thrombosis occurred in 39 patients (0.46%) after 30 days.

The researchers found that absolute and relative levels of platelet inhibition in response to ADP antagonists as assessed by the VerifyNow P2Y12 test are powerful independent predictors of stent thrombosis within 30 days, with a significant proportion of events independently attributable to clopidogrel hyoporesponsivenes.

In contrast, the baseline level of platelet P2Y12 response, as well as aspirin and overall platelet responsiveness after DAPT loading as assessed by VerifyNow were not shown to be related to the 30-day rate of stent thrombosis.

"These results suggest that agents which more effectively inhibit ADP-induced platelet activation should reduce 30-day stent thrombosis when applied to large patient populations," said lead investigator, Gregg W. Stone, MD. Dr. Stone is Director of Cardiovascular Research and Education at NewYork-Presbyterian Hospital/Columbia University Medical Center and Professor of Medicine, Division of Cardiology at Columbia University College of Physicians and Surgeons. Dr. Stone also serves as Co-Director, Medical Research & Education Division at the Cardiovascular Research Foundation.

"However, the modest sensitivity and specificity of platelet function testing, coupled with the low prevalence of events, implies that testing of platelet ADP antagonist responsiveness is unlikely to provide useful information to guide clinical decision-making in most individual patients for the prevention of stent thrombosis at 30 days," said Dr. Stone.

"The degree of platelet responsiveness to antiplatelet loading is useful to predict 30-day stent thrombosis in diabetic and non-diabetic patients, as well as those with ACS, but may have less clinical utility in patients with stable coronary artery disease (CAD)," Dr. Stone said.

"There was a low stent thrombosis rate in patients with stable CAD, which coupled with the poor prognostic utility of platelet function testing in this setting, suggests that assessing DAPT response in patients without ACS undergoing PCI is unlikely to provide incremental clinical utility. The relationship between platelet responsiveness testing and the occurrence of late and very late stent thrombosis, in patients who have maintained and discontinued DAPT, will be assessed during the two-year clinical follow-up phase of the ADAPT-DES study."
-end-
The ADAPT-DES trial is sponsored by the Cardiovascular Research Foundation with research support from Boston Scientific, Abbott Vascular, Medtronic, Cordis, Biosensors, The Medicines Company, Daiichi Sankyo, Eli Lilly, Volcano, and Accumetrics. Dr. Stone reported consulting fees and honoraria from Abbott Vascular, Boston Scientific, Medtronic, Volcano, The Medicines Company, Daiichi Sankyo and Eli Lilly.

About CRF and TCT

The Cardiovascular Research Foundation (CRF) is an independent, academically focused nonprofit organization dedicated to improving the survival and quality of life for people with cardiovascular disease through research and education. Since its inception in 1991, CRF has played a major role in realizing dramatic improvements in the lives of countless numbers of patients by establishing the safe use of new technologies, drugs and therapies in interventional cardiovascular medicine.

Transcatheter Cardiovascular Therapeutics (TCT) is the annual scientific symposium of the Cardiovascular Research Foundation. TCT gathers leading medical researchers and clinicians from around the world to present and discuss the latest developments in the field.

For more information, visit www.crf.org.

Cardiovascular Research Foundation

Related Aspirin Articles from Brightsurf:

An aspirin a day keeps the bowel doctor away
A regular dose of aspirin to reduce the risk of inherited bowel cancer lasts at least 10 years after stopping treatment, research has revealed.

What are the risks and benefits of low-dose aspirin?
Low-dose aspirin significantly lowers cardiovascular disease risk but increases the risk of bleeding, according to a review published in the British Journal of Clinical Pharmacology.

Benefit seen for ticagrelor alone, without aspirin, in patients with ACS
The research was presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Study: An aspirin a day does not keep dementia at bay
Taking a low-dose aspirin once a day does not reduce the risk of thinking and memory problems caused by mild cognitive impairment or probable Alzheimer's disease, nor does it slow the rate of cognitive decline, according to a large study published in the March 25, 2020, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Aspirin's health benefits under scrutiny
Taking a baby aspirin every day to prevent a heart attack or stroke should no longer be recommended to patients who haven't already experienced one of these events.

Aspirin may no longer be effective as cardiovascular treatment
A new paper in Family Practice, published by Oxford University Press, found that the widespread use of statins and cancer screening technology may have altered the benefits of aspirin use.

Migraine headaches? Consider aspirin for treatment and prevention
Evidence from 13 randomized trials of the treatment of migraine in 4,222 patients and tens of thousands of patients in prevention of recurrent attacks supports the use of high dose aspirin from 900 to 1,300 milligrams to treat acute migraine as well as low dose daily aspirin from 81 to 325 milligrams to prevent recurrent attacks.

Aspirin use after biliary tract cancer diagnosis
Researchers in this observational study examined if aspirin use after a diagnosis of a biliary tract cancer, which includes gallbladder cancer, was associated with reduced risk of death among nearly 3,000 patients.

Aspirin may prevent air pollution harms
A new study is the first to report evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin may lessen the adverse effects of air pollution exposure on lung function.

Aspirin should not be recommended for healthy people over 70
Low-dose aspirin does not prolong disability-free survival of healthy people over 70, even in those at the highest risk of cardiovascular disease.

Read More: Aspirin News and Aspirin Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.