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Antiplatelet therapy in the primary prevention of cardiovascular diseasein patients with chronic obstructive pulmonary disease: a randomised controlled proof-of-concept trial

Lookup NU author(s): Professor Vijay KunadianORCiD, Dr Nina WilsonORCiD, Dr Deborah Stocken, Emerita Professor Elaine McCollORCiD, Dr Graham Burns, Nicola Howe, Professor Andrew FisherORCiD, Professor Anthony De SoyzaORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


The APPLE COPD-ICON2 trial is a prospective 2×2 factorial, double-blinded proof-of-conceptrandomised controlled trial targeting patients with chronic obstructive pulmonary disease (COPD) without priorhistory of cardiovascular disease. The primary goal of this trial is to investigate if treatment with antiplatelet therapywill 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 ticagreloror placebo only for 6 months. The primary outcome comprises inhibition (binary response) of arachidonicacid- (ASPI test, cut-off <40) and adenosine diphosphate- (ADP test, cut-off <46) induced plateletaggregation at 6 months.543 patients were screened and 120 patients were recruited with mean age of 67.5 years; 47.5% patientswere male. The per-protocol ASPI test response rate to aspirin was 68.3% (95% CI 52.3–80.9%). The perprotocolADP 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-thirdof COPD patients without prior history of cardiovascular disease. These findings support the high prothromboticmilieu and the need for further research to determine the effect of antiplatelet/antithrombotictherapy on cardiovascular morbidity and mortality in COPD patients.

Publication metadata

Author(s): Kunadian V, Wilson N, Stocken D, Hani A, McColl E, Burns G, Howe N, Fisher A, De Soyza A

Publication type: Article

Publication status: Published

Journal: ERJ Open Research

Year: 2019

Volume: 5

Issue: 3

Online publication date: 05/08/2019

Acceptance date: 11/06/2019

Date deposited: 29/10/2019

ISSN (electronic): 2312-0541

Publisher: European Respiratory Society


DOI: 10.1183/23120541.00110-2019


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