VerifyNow in acute coronary syndrome: design of the EPIC17-VERONICA trial to optimize platelet inhibition.

Introduction and objectives: De-escalation from prasugrel and ticagrelor to clopidogrel in patients undergoing percutaneous coronary intervention after acute coronary syndrome (ACS) is a strategy aimed at reducing bleeding. This study evaluates whether VerifyNow (Werfen, Spain)-guided de-escalation, based on platelet aggregation measurement, provides a therapeutic benefit in ACS management. Methods: This ongoing multicenter, prospective, randomized 1:1 trial will enroll 634 patients with ACS who underwent revascularization with a sirolimus-eluting stent and were discharged on dual antiplatelet therapy with ticagrelor or prasugrel. Only those patients with a very low platelet reactivity level (platelet reactivity units ≤ 30) based on VerifyNow 1 month after discharge will be included. The primary endpoint is a composite of cardiovascular death, nonfatal acute myocardial infarction, nonfatal stroke, and bleeding at 1-year follow-up. Results: The EPIC17-VERONICA study (NCT04654052) will reveal the efficacy profile of the de-escalation strategy, based on the VerifyNow platelet aggregation test, and determine the role of this device in the selection of patients who are eligible to benefit from this strategy. Conclusions: This study will determine whether platelet function testing provide clinical benefit in the management of patients with ACS.