Antiplatelet therapy in the primary prevention of cardiovascular disease in patients with chronic obstructive pulmonary disease: a randomised controlled proof-of-concept trial.
Journal
ERJ open research
ISSN: 2312-0541
Titre abrégé: ERJ Open Res
Pays: England
ID NLM: 101671641
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
08
05
2019
accepted:
11
06
2019
entrez:
13
8
2019
pubmed:
14
8
2019
medline:
14
8
2019
Statut:
epublish
Résumé
The APPLE COPD-ICON2 trial is a prospective 2×2 factorial, double-blinded proof-of-concept randomised controlled trial targeting patients with chronic obstructive pulmonary disease (COPD) without prior history of cardiovascular disease. The primary goal of this trial is to investigate if treatment with antiplatelet therapy will produce the predefined cut-off of platelet inhibition measured using the Multiplate test in COPD patients. Eligible patients were randomised to aspirin plus placebo, ticagrelor plus placebo, aspirin plus ticagrelor or placebo only for 6 months. The primary outcome comprises inhibition (binary response) of arachidonic acid- (ASPI test, cut-off <40) and adenosine diphosphate- (ADP test, cut-off <46) induced platelet aggregation at 6 months. 543 patients were screened and 120 patients were recruited with mean age of 67.5 years; 47.5% patients were male. The per-protocol ASPI test response rate to aspirin was 68.3% (95% CI 52.3-80.9%). The per-protocol ADP test response rate to ticagrelaor was 68.8% (95% CI 50.4-82.6%). Platelet response to antiplatelet therapy with aspirin and ticagrelor was not observed in nearly one-third of COPD patients without prior history of cardiovascular disease. These findings support the high pro-thrombotic milieu and the need for further research to determine the effect of antiplatelet/antithrombotic therapy on cardiovascular morbidity and mortality in COPD patients.
Identifiants
pubmed: 31403053
doi: 10.1183/23120541.00110-2019
pii: 00110-2019
pmc: PMC6680071
pii:
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : British Heart Foundation
ID : CS/15/7/31679
Pays : United Kingdom
Déclaration de conflit d'intérêts
Conflict of interest: V. Kunadian has nothing to disclose. Conflict of interest: N. Wilson has nothing to disclose. Conflict of interest: D. Stocken has nothing to disclose. Conflict of interest: H. Ali has nothing to disclose. Conflict of interest: E. McColl has nothing to disclose. Conflict of interest: G. Burns has nothing to disclose. Conflict of interest: N. Howe has nothing to disclose. Conflict of interest: A. Fisher has nothing to disclose. Conflict of interest: A. De Soyza has nothing to disclose.
Références
Am J Respir Crit Care Med. 2001 Apr;163(5):1256-76
pubmed: 11316667
Am J Respir Crit Care Med. 2002 Aug 1;166(3):333-9
pubmed: 12153966
Circulation. 2003 Mar 25;107(11):1514-9
pubmed: 12654609
Ann Epidemiol. 2006 Jan;16(1):63-70
pubmed: 16039877
Chest. 2005 Nov;128(5):3618-24
pubmed: 16304321
Stat Med. 2008 Feb 20;27(4):568-83
pubmed: 17573688
Thorax. 2011 Sep;66(9):769-74
pubmed: 21507906
Circulation. 2011 Jun 14;123(23):2736-47
pubmed: 21670242
Lung. 2011 Aug;189(4):261-8
pubmed: 21678045
Eur Heart J. 2011 Dec;32(23):2945-53
pubmed: 21804104
Am J Respir Crit Care Med. 2012 Jul 15;186(2):155-61
pubmed: 22561964
Cardiol Rev. 2013 Jul-Aug;21(4):196-202
pubmed: 23095685
Curr Med Res Opin. 2013 May;29(5):569-77
pubmed: 23448616
Thorax. 2014 Jan;69(1):80-1
pubmed: 23878160
Thorax. 2014 Aug;69(8):718-23
pubmed: 24473329
Thorax. 2014 Jul;69(7):609-15
pubmed: 24743560
EuroIntervention. 2014 Jun;10(2):204-11
pubmed: 24952058
J Thromb Thrombolysis. 2015 Jan;39(1):1-7
pubmed: 25085573
PLoS One. 2015 Apr 13;10(4):e0123292
pubmed: 25875204
J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2385-9
pubmed: 26232890
J Am Heart Assoc. 2015 Oct 09;4(10):e002490
pubmed: 26452988
Thromb Haemost. 2016 Nov 30;116(6):1140-1149
pubmed: 27628615
Anatol J Cardiol. 2017 Feb;17(2):113-118
pubmed: 27721320
Thromb Haemost. 2017 Mar 23;117(6):1208-1216
pubmed: 28331925
Cardiology. 2017;138(3):164-168
pubmed: 28697492
Platelets. 2018 May;29(3):257-264
pubmed: 29580115
BMJ Open. 2018 May 26;8(5):e020713
pubmed: 29804061
JAMA. 2019 Jan 22;321(3):277-287
pubmed: 30667501
Clin Cardiol. 2019 May;42(5):498-505
pubmed: 30788847
Eur Respir J. 1997 Dec;10(12):2794-800
pubmed: 9493663