News | Antiplatelet and Anticoagulation Therapies | August 18, 2016

Antiplatelet Agent Genetic Testing TAILOR-PCI Study Receives $7 Million NHLBI Grant

Study begun in 2013 assessing whether prescribing antiplatelet medication based on genotype will help prevent heart attack, stroke, unstable angina and cardiovascular death in PCI patients

TAILOR-PCI study, antiplatelet medication, genotype, NHLBI grant

August 18, 2016 — Researchers at the Peter Munk Cardiac Centre, Toronto, and at Mayo Clinic are leading the Tailored Antiplatelet Therapy to Lessen Outcomes after Percutaneous Coronary Intervention (TAILOR-PCI) study. This study has received $7 million in additional funding from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH). When it began in 2013, TAILOR-PCI included study teams at 15 hospitals from Canada, the United States and South Korea, with a goal of enrolling 5,270 patients. Now, some 29 medical centers are participating, with more expected. The study involves the randomized comparison of clopidogrel bisulfate (Plavix) and ticagrelor (Brilinta), based on genetic testing that identifies resistance to ticagrelor in patients undergoing coronary balloon angioplasty.

The study is examining whether prescribing heart medication based on a patient’s CYP2C19 genotype will help prevent heart attack, stroke, unstable angina and cardiovascular death in patients who undergo percutaneous coronary intervention (PCI). A PCI, commonly known as an angioplasty, is a non-surgical procedure that opens up narrowed or blocked blood vessels in the heart.

“The significance and potential far-reaching impact of a clinical trial of this scope will push the boundaries about the benefits that personalized medicine for patients who undergo a coronary stent procedure can provide,” said Barry Rubin, M.D., medical director, Peter Munk Cardiac Centre, University Health Network (UHN). “The validation provided by the NHLBI through this important grant is further evidence of our leadership role in large-scale cardiovascular studies requiring international clinical trials expertise and a multi-disciplinary team approach,” he said. “This is the largest trial to evaluate a personalized molecular medicine approach to patients with heart disease that has even been carried out.”

The study was launched by Mayo Clinic Center for Individualized Medicine and the Department of Cardiovascular Diseases at Mayo Clinic, in collaboration with the Peter Munk Cardiac Centre, the Applied Health Research Centre at the University of Toronto and Spartan Bioscience, Ottawa.

“This is a multinational collaboration designed to inform clinical practice, in its truest sense,” said Michael Farkouh, M.D., cardiologist, chair, Peter Munk Centre of Excellence in Multinational Clinical Trials and one of two principal investigators of TAILOR-PCl. The other principal investigator is Naveen Pereira, M.D., cardiologist at the Mayo Clinic. “We are delighted to partner with the Mayo Clinic in this effort,” said Farkouh.

“NHLBI is happy to support this important study, which we hope will contribute to the evidence needed to start delivering precision medicine in clinical settings,” said Yves Rosenberg, M.D,. NHLBI program officer for the study, and chief of the Atherothrombosis and Coronary Artery Disease Branch. “This trial could have global impact by potentially changing treatment recommendations for millions of individuals with coronary artery disease needing antiplatelet treatment after a percutaneous coronary intervention.”

Antiplatelet medication has been shown to reduce the risk of heart attack, unstable angina, stroke and cardiovascular death after stent placement by reducing the possibility of blood clots around the site of the surgical incision. The current standard of care after angioplasty is to prescribe clopidogrel for one year.

“Today, we do this regardless of a person’s individual genotype, even though we have known for several years that variation in the CYP2C19 gene may diminish the benefit from the drug,” said Pereira. “What we don’t know — and why there is such confusion in the cardiovascular community — is whether these genetic differences affect long-term clinical outcomes.”

Read the article “Questions Remain on DAPT Prolongation”

For more information: www.petermunkcardiaccentre.ca

Related Content

One-month Clopidogrel Monotherapy After PCI Not Supported in STOPDAPT-2 ACS Trial 
News | Antiplatelet and Anticoagulation Therapies | September 01, 2021
September 1, 2021 — The STOPDAPT-2 ACS trial does not support the use of one month of dual...
The anticoagulant edoxaban (Savaysa) may be just as effective as warfarin for preventing heart attack or stroke in patients with AFib who undergo transcatheter aortic valve replacement (TAVR), according to an ESC late-breaking trial.

The anticoagulant edoxaban (Savaysa) may be just as effective as warfarin for preventing heart attack or stroke in patients with AFib who undergo transcatheter aortic valve replacement (TAVR), according to an ESC late-breaking trial.

News | Antiplatelet and Anticoagulation Therapies | September 01, 2021
September 1, 2021 – The anticoagulant edoxaban (Savaysa) may be just as effective as warfarin for preventing heart at
The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in patients with pre-existing cardiovascular disease who were taking 81 milligrams (mg) baby aspirin, versus 325 mg of daily aspirin. Getty Images #ACC #ACC21 #ACC2021

The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in patients with pre-existing cardiovascular disease who were taking 81 milligrams (mg) baby aspirin, versus 325 mg of daily aspirin. Getty Images

News | Antiplatelet and Anticoagulation Therapies | May 15, 2021
May 15, 2021 — The ADAPTABLE trial found no significant differences in cardiovascular events or major bleeding in pat
A Chinese registry study found there are higher event rates in patients with shorter dual-antiplatelet therapy (DAPT) after PCI procedures. There has been a lot of movement toward using shorter duration DAPT with newer generation drug-eluting stent technologies, but this study reinforces the need longer DAPT in many patients. The findings were presented as a late-breaking trial at SCAI 2021 today. 

A Chinese registry study found there are higher event rates in patients with shorter dual-antiplatelet therapy (DAPT) after PCI procedures. There has been a lot of movement toward using shorter duration DAPT with newer generation drug-eluting stent technologies, but this study reinforces the need longer DAPT in many patients. The findings were presented as a late-breaking trial at SCAI 2021 today. 

News | Antiplatelet and Anticoagulation Therapies | April 28, 2021
April 28, 2021 — An analysis of the prospective Chinese Fuwai PCI Registry, confirms long-term,...
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can potentiate all 3 sides of Virchow’s Triad of coagulopathy, including endothelial dysfunction, blood flow stasis, and hypercoagulability. Angiotensin-converting enzyme-2 (ACE-2)–dependent viral entry and the virus-induced inflammatory response can lead to endothelial dysfunction. Clotting Prevention in COVID-19 Patients, Thrombosis Prevention in COVID-19 Patients, Preventing blood clots in COVID-19 patients

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can potentiate all 3 sides of Virchow’s Triad of coagulopathy, including endothelial dysfunction, blood flow stasis and hypercoagulability. Angiotensin-converting enzyme-2 (ACE-2)–dependent viral entry and the virus-induced inflammatory response can lead to endothelial dysfunction. Additional figure included in the JACC article.

Feature | Antiplatelet and Anticoagulation Therapies | March 22, 2021 | By Dave Fornell, Editor
A comprehensive review or more than 80 randomized controlled trials (RCTs) investigating how to best manage optimal a
Tailor PCI trial showed genetic testing may play a role in personalizing antiplatelet therapy after PCI.
News | Antiplatelet and Anticoagulation Therapies | September 02, 2020
September 2, 2020 — An international, first-of-its-kind cardiology trial used personalized genetic testing to reduce