MADONNA: Personalized antiplatelet therapy savior for angioplasty patients?

By Piriya Mahendra, medwireNews Reporter

Personalized antiplatelet treatment may improve cardiac outcomes after percutaneous coronary intervention (PCI), researchers suggest.

Jolanta Siller-Matula (Medical University of Vienna, Austria) presented the findings of the Multiple Electrode Aggregometry in Patients Receiving Dual Antiplatelet Therapy to Guide Treatment with Novel Platelet Antagonists (MADONNA) study at the European Society of Cardiology Congress in Munich, Germany.

The study findings suggest that PCI patients who were not classified as clopidogrel responders or nonresponders had an increased risk for adverse outcomes after undergoing the procedure than patients who were classified.

Indeed, patients who were not classified as being responders or nonresponders to clopidogrel had a significant 7.9-fold higher risk for stent thrombosis than those who were classified. Furthermore, acute coronary syndrome occurred in 2.5% of patients who were not classified compared with none of those in the group that was classified.

There were no significant differences between the groups with respect to cardiac death or major bleeding rates.

"Introducing clopidogrel testing into clinical practice might be feasible: it involves a blood sample and takes ten minutes to get a result," commented Siller-Matula to the press. "Providing individualized treatment based on the results of multiple electrode aggregometry instead of using novel antiplatelet drugs in each patient would save costs of drug therapy of about € 410 [US$ 515.32] per patient each year.

"As individualized antiplatelet therapy seems to be cost-effective, it might be of interest to health authorities."

The study involved 728 patients who underwent platelet testing with whole blood aggregometry using the multiple electrode aggregometry technique, which classified patients as clopidogrel responders or nonresponders. All patients were then allocated to either the guided group (n=403) or the nonguided group (n=395).

In the guided group, patients who were nonresponders to clopidogrel (26%) received treatment with up to four loading doses of clopidogrel or prasugrel. Patients in the nonguided group who were nonresponders to clopidogrel (25%) were treated with the standard regimen of clopidogrel plus aspirin.

Siller-Matula pointed out: "Physicians would never adjust doses of antihypertensive drugs without knowing blood pressures; statins without knowing cholesterol levels; or antidiabetic drugs without knowing the HbA1C levels.

"So why are we still treating our patients with platelet inhibitors without being aware of levels of platelet inhibition?"

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