Platelet Reactivity (High On-Treatment Platelet Reactivity) as Guidance for APT (Antiplatelet Therapy) Adjustment After PCI (Percutaneous Coronary Intervention)
Condition: PRU(Platelet Reactivity Unit); APT(Antiplatelet Therapy); HOTPR(High on Treat Platelet Reactivity)
Study type: Observational

Summary: 
      Since thrombus formation is a very complex procedure in vivo, platelet function testing
      methods in vitro might only reflect the degree of inhibition of platelet from a certain
      level, which do't reflect the functional status of platelets in vivo adequately. There are a
      variety of signal transduction pathways involved in the formation of platelet activation and
      thrombosis. Gurbel et al. first reported individuals with variability on clopidogrel
      treatment response in 2003, and proposed the concept of clopidogrel resistance. Different
      patients received the same dose of aspirin or other anti -platelet drug such as clopidogrel ,
      due to various reasons bound to lack some patients antithrombotic efforts to increase the
      incidence of thrombotic events , while another part of the patient easily understood
      antithrombotic excessive bleeding events, " antithrombotic individualized treatment , "
      according to differences in patient against platelet drugs or anticoagulant drug reactions
      and adjust the treatment plan , is the direction of antithrombotic therapy in the future.

      There are a number of studies have shown that patients with no response Clopidogrel ,
      measuring the relationship between high platelet reactivity and clinical adverse ischemic
      events displayed between platelet activity . However, there is still lack of quantitative
      threshold high platelet reactivity and the risks associated with the clinical consensus . In
      addition, there are only limited data support, to measure platelet function -based therapy to
      improve the clinical efficacy of the concept . Over the years, more than 20,000 cases
      reported in patients with numerous studies confirm that high platelet reactivity after PCI
      with stent thrombosis , including cardiovascular events , including an increased risk of
      significant correlation . Pharmacodynamic analysis GRVITAS trial showed significantly lower
      platelet reactivity associated with a lower risk of adverse cardiovascular events . Brar in
      more than 3000 cases of patients published in JACC Meta-analysis showed that "high platelet
      reactivity " of patients whose cardiovascular death, heart attack and stent thrombosis
      occurred more than twice the rate of " non-high platelet reactivity " patients .

      Two new anti-platelet drugs (Prasugrel and Ticagrelor) in several recent randomized trials
      have considerable persuasive , and has included some guidance in the current guidelines.
      Ticagrelor even more than Prasugrel in pharmacodynamic studies more effectively inhibit
      platelet , and has a lower risk of bleeding. Cilostazol is an old drug , mostly for the
      treatment of intermittent claudication , in recent years there are also some testing and
      coronary stents prevent restenosis after angioplasty , however, so far , there is little
      direct comparison Cilostazol and Ticagrelor related articles .

      We designed this test , in addition to testing for high yellow people treat DAPT (dual
      anti-platelet therapy) under the platelet reactivity (high on-treatment platelet reactivity)
      ratio , this population of patients with ticagrelor instead for a month or cilostazol
      treatment after its platelet reactivity changes and compare between the two groups , and even
      track six months after the bleeding and adverse cardiovascular events rate? Through this test
      we can compare the treatment for patients with high platelet reactivity of what strategies
      more appropriate.
    


Intervention name(s): PRU(Platelet reactivity unit)
Intervention type(s): Diagnostic Test
Intervention description(s): measure by VeryfyNow.
Other intervention name(s): Platelet reactivity unit
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        stable angina who received routine dual antiplatelet agents therapy.