1. Randomisation before planned PCI with DES (n=2500)
Assessment with a double Randomization of 1) a monitoring-adjusted antiplatelet treatment vs. a Common antiplatelet Treatment for DES implantation, and 2) Interruption vs. Continuation of double antiplatelet therapy one year after stenting
Randomisation before planned PCI with DES (n=2500)
Monitoring Treatment Arm
-Systematic assessment of the pharmacodynamic response to clopidogrel and aspirin before DES placement and between D14-D30.
2-Adjustment of APT* dose regimen if high-on treatment platelet reactivity before DES placement**
3-Adjustment of APT* dose regimen if high-on treatment platelet reactivity during the maintenance phase d14-30 )**
Conventionnal Arm
- No monitoring of pharmacodynamic platelet response
- APT* strategy is left at the physician discretion according to routine practice
Systematic Assessment of the biological response to both aspirin and clopidogrel beforre drug eluting stent placement and at day 7-14
Adjustment of the dose regimen of oral antiplatelet treatment in suboptimal responders
VASP @ day 1 and before discharge
Assessment of the primary endpoint at 1 year (minimal FU of 6 months for the last patients)
All Cause Mortality
Myocardial Infarction
All Urgent Revascularization
Stent Thrombosis requiring revascularization or not
Ischemic Stroke requiring a new hospitalization
*APT = Antiplatelet Therapy; **In the absence of high-on treatment platelet reactivity: DAPT dose regimen is 75mg of aspirin and 75mg of clopidogrel

2. ARU>550 %inh<15%/PRU>235 %inh>90%
Planned PCI with DES, pretreated with aspirin and clopidogrel/prasugrel
(local practice) and randomized to the Monitoring Treatment Arm
VerifyNow before PCI : Aspirin & P2Y12 Thienopyridine
ARU>550 (Aspirin cartridge)
%inh<15% /PRU>235 (P2Y12 cartridge)
Reload with 500 mg
of IV aspirin
GPIIb/IIIa inh. + clopidogrel (re)-loading (>or=600 mg) or prasugrel 60 mg and maintenance dose of 150 mg or prasugrel 10mg*
day Aspirin & P2Y12 thienopyridine for all patients
ARU>550
%inh<15%/PRU>235
%inh>90%
Doubling the aspirin dose
↗ Clopidogrel dose by at least 75 mg or switch to prasugrel 10mg*
if clopidogrel 150mg, ↘ to 75mg or if on prasugrel switch to clopidogrel 75mg *
Not indicated if previous stroke. Caution in patients >75 yo or <60kg.
Indicated if Acute stent thrombosis or at least 2 of the following risk factors:
(i) diabetes or overweight (BMI>30); (ii) High on-treatment platelet reacitivty; (iii) carriage of the 2C19*2 variant