In patients deemed to have very low platelet reactivity, switching from more potent P2Y12 inhibitors to clopidogrel did not improve outcomes at one year, according to findings from the EPIC17-VERONICA trial presented at TCT 2026.

Iñigo Lozano, MD, DSc, FACC, et al., tested 810 patients at 16 hospitals in Spain who underwent stent placement one month prior due to acute coronary syndrome. Patients who showed low reactivity on the VerifyNow platelet blood test (P2Y12 reaction units ≤30; n=637) were randomized to either continue their current regimen (ticagrelor or prasugrel) or switch to clopidogrel.

The study's primary endpoint was net adverse clinical events, including cardiovascular death, myocardial infarction, stroke or clinically relevant bleeding at one year. They report no significant difference in the study's primary endpoint (13.2% in the continuation group vs. 11.9% in the clopidogrel group; hazard ratio 0.88 [95% CI: 0.57-1.37]; p=0.74).

Lozano notes that the trial results "do not support routine platelet-test-guided switching to clopidogrel over standard potent therapy." He adds that the choice of drug should remain individualized, taking into account a person's bleeding and clotting risks.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Transcatheter Cardiovascular Therapeutics, TCT26, Acute Coronary Syndrome, Clopidogrel, Prasugrel Hydrochloride, Ticagrelor, Myocardial Infarction, Stents, Stroke