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Background and Aims:  Glycoprotein VI (GPVI) is the major platelet-specific collagen receptor. GPVI shedding with generation of soluble GPVI (sGPVI) is an endogenous feedback mechanism preventing platelet overstimulation. sGPVI has not been investigated in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), especially regarding its potential value as a predictor of ischemic and bleeding risk., Methods:  Baseline plasma sGPVI levels were available in 318 patients with CCS undergoing PCI. Platelet function was assessed by measuring both adenosine diphosphate (ADP) and collagen-induced platelet aggregation. Co-primary endpoints were a composite of death or myocardial injury at 48 hours after PCI, and Bleeding Academic Research Consortium (BARC) type 1 to 5 bleeding at 30 days., Results:  There was no significant correlation between sGPVI and platelet function at baseline or at 48 hours after PCI and loading with antiplatelet drugs. Baseline plasma sGPVI levels were not associated with the ischemic risk: the incidence of the ischemic endpoint was 25.0% in the lower, 22.9% in the middle, and 26.7% in the upper sGPVI tertile ( p  = 0.82). There was a significant nonlinear relationship between sGPVI and the risk of bleeding: the incidence of the bleeding endpoint was 11.8% in the lower, 12.6% in the middle, and 26.4% in the upper sGPVI tertile ( p  = 0.006)., Conclusion:  In patients with CCS undergoing PCI, plasma levels of sGPVI did not correlate with ADP- or collagen-induced platelet aggregation. Patients with higher baseline levels of sGPVI may carry an increased risk of bleeding at 30 days after PCI but no excess risk of ischemic events., Competing Interests: R.H.-R. reported grants from German Center for Cardiovascular Research, Deutsches Herzzentrum München, the Federal Ministry of Education and Research, and advanceCOR GmbH during the conduct of the study. I.B. reported personal fees from Sysmex Europe GmbH outside the submitted work. S.S. reported grants from Else Kröner-Fresenius-Stiftung (Else Kröner-Memorial grant) during the conduct of the study and DZHK (German Center for Cardiovascular Research) for the Intracoronary Stenting and Antithrombotic Regimen: Lesion Platelet Adhesion as Selective Target of Endovenous Revacept in Patients with Chronic Coronary Syndromes Undergoing Percutaneous Coronary Intervention trial and personal fees from Bayer Vital GmbH, Daiichi Sankyo, and Biopas Laboratories outside the submitted work. S.H. has received research grants and honoraria from Roche Diagnostics, Bristol Myers Squibb, Merck KGaA, Sysmex Inostics, and Volition SPRL outside the submitted work. M.G. is cofounder of advanceCor, the manufacturer of Revacept. H.S. reports honoraria from AstraZeneca, Bayer Vital, MSD Sharp & Dohme, Novartis, Servier, Sanofi-Aventis, Boehringer Ingelheim, Daiichi Sankyo, Amgen, Pfizer and consulting fees from AstraZeneca, Amgen, MSD Sharp & Dohme, not related to the current work. G.M. is the founder of advanceCOR GmbH, Martinsried, Germany. K.A. is employee of advanceCOR GmbH, Martinsried, Germany., (Thieme. All rights reserved.)

Background:  The relative efficacy and safety of ticagrelor and prasugrel based dual antiplatelet therapy strategies according to the platelet count (PC) in patients with acute coronary syndromes (ACS) have not been defined., Methods:  This is a posthoc analysis of the ISAR-REACT 5 trial, in which patients presenting with ACS were randomized to treatment with ticagrelor versus prasugrel. Patients were divided into quartiles according to PC. The primary endpoint was incidence of death, myocardial infarction, or stroke, and the safety endpoint was incidence of BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 12 months., Results:  A total of 3,943 patients with known PC (997 patients in quartile 1 (Q1), 1,003 in quartile 2 (Q2) [205 ± 10.3 × 10 9 /L], 961 patients in quartile 3 (Q3) [241 ± 11.7 × 10 9 /L], and 982 patients in quartile 4 (Q4) [317 ± 68.6 × 10 9 /L]). There was no significant interaction between treatment arm (ticagrelor vs. prasugrel) and PC group with respect to primary endpoint (Q1: 8.8 vs. 6.3%, hazard ratio [HR] =1.41, 95% confidence interval [CI]: 0.89-2.23; p  = 0.148; Q2: 9.9 vs. 5.8%, HR = 1.68, 95% CI: 1.06-2.66; p  = 0.027; Q3: 7.8 vs. 5.5%, HR = 1.43, 95% CI: 0.87-2.37; p  = 0.159; Q4: 10.1 vs. 10.1%, HR = 1.05, 95% CI: 0.71-1.57; p  = 0.799; p for interaction [ p int ] = 0.482) and with respect to bleeding endpoint (Q1: 5.8 vs. 4.2%, HR = 1.41, 95% CI: 0.76-2.63; p  = 0.279; Q2: 6.4 vs. 3.7%, HR = 1.62, 95% CI: 0.85-2.06; p  = 0.140; Q3: 4.4 vs. 3.0%, HR = 1.53, 95% CI: 0.73-3.18; p  = 0.258; Q4: 5.6 vs. 8.5%, HR = 0.67, 95% CI: 0.40-1.14; p  = 0.138, p int  = 0.102)., Conclusions:  In this analysis, incidences of ischemic and bleeding events at 12 months are comparable across quartiles of platelet count., Competing Interests: D.J.A. reports consulting fees or honoraria from Abbott, Amgen, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, and Sanofi; and research grants to his institution from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, Renal Guard Solutions, and Scott R. MacKenzie Foundation. H.S. reports honoraria from AstraZeneca, Bayer Vital, MSD SHARP&DOHME, Novartis, Servier, Sanofi-Aventis, Boehringer Ingelheim, Daiichi Sankyo, Amgen, and Pfizer, and consulting fees from AstraZeneca, Amgen, and MSD SHARP&DOHME. S.K. reports consulting and lecture fees from Astra Zeneca, Bristol-Myers Squibb, and Translumina. T.K. is named inventor on a patent application for prevention of restenosis after angioplasty and stent implantation outside the submitted work and received lecture fees from Bayer AG, Pharmaceuticals; M.J. reports speaker fees from Biotronik, personal fees from OrbusNeich, grants and personal fees from Boston Scientific, grants and personal fees from Edwards, personal fees from AstraZeneca, personal fees from Recor, grants from Amgen, not related to the current work., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)