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HOST-ASSURE: 1-year outcomes similar for triple antiplatelet therapy, clopidogrel double dose
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LAS VEGAS — At 1 year, outcomes for patients assigned triple antiplatelet therapy for 1 month after PCI were similar to outcomes for patients assigned a double dose of clopidogrel, according to new findings from the HOST-ASSURE trial.
Researchers for the prospective, all-comers trial randomly assigned patients (mean age, 63 years; 70% men) to 150 mg clopidogrel, twice the normal dose (n=1,876), or to a triple antiplatelet therapy regimen of aspirin, 75 mg clopidogrel and cilostazol (n=1,879), for 1 month after PCI with a drug-eluting stent, Kyung Woo Park, MD, PhD, of Seoul National University Hospital in Seoul, Korea, said during a presentation at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“There are situations where after PCI, we need to use intense antiplatelet therapy,” he said. “We know that inhibition of platelet reactivity in the first month after PCI is critical for preventing thrombotic events. Before the era of new agents such as prasugrel [Effient, Daiichi Sankyo/Eli Lilly] and ticagrelor [Brilinta, AstraZeneca], one method was to use a double dose of clopidogrel. However, in Asia, particularly in Korea, many physicians prescribed cilostazol on top of the conventional dual antiplatelet therapy. However, there had been no previous head-to-head comparison between double-dose [clopidogrel] and triple antiplatelet therapy.”
The primary outcome was a composite of cardiac death, nonfatal MI, stent thrombosis, stroke and PLATO major bleeding. The researchers had previously reported that at 1 month, triple antiplatelet therapy was noninferior to 150 mg clopidogrel for prevention of the primary outcome, Park said.
No difference in most outcomes
At 1 year, there was no difference in the primary outcome between patients assigned 150 mg clopidogrel and those assigned triple antiplatelet therapy (3.6% vs. 3.9%; HR=1.07; 95% CI, 0.77-1.49). There also was no difference between the groups in the secondary endpoint of all-cause death, MI or repeat revascularization (5% vs. 5.1%; P=.95), Park said.
In addition, the groups did not differ in the individual secondary endpoints of cardiac death (HR=1.03; 95% CI, 0.6-1.79), MI (HR=0.69; 95% CI, 0.36-1.25), stroke (HR=0.92; 95% CI, 0.42-2.01) or definite/probable stent thrombosis (HR=0.54; 95% CI, 0.2-1.47). However, Park said, the triple antiplatelet therapy group was slightly more likely to have PLATO major bleeding (0.8% vs. 1.5%; HR=1.87; 95% CI, 1-3.49). Most of the difference for bleeding occurred in the first month after PCI.
There were no differences in outcomes among subgroups, according to Park.
Triple therapy lowered platelet reactivity
On-clopidogrel platelet reactivity was higher in the 150-mg clopidogrel group than in the triple antiplatelet therapy group, both at 12 hours to 24 hours after the loading dose and at 1 month after a maintenance dose (P<.001 for both).
“Triple antiplatelet therapy was more potent in terms of on-clopidogrel platelet reactivity,” Park said. “It showed trends for lower incidence of stent thrombosis and MI, and a higher incidence of bleeding than [150 mg clopidogrel].” – by Erik Swain
For more information:
Park KW. Best of the Best Abstracts: Abstract O-007. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.
Disclosure: Park reports no relevant financial disclosures.