EPIC17-VERONICA Evaluates Platelet Reactivity Testing to Guide P2Y12 Inhibitor De-Escalation From Antiplatelet Agents 

November 5, 2026—The EPIC17-VERONICA study found no evidence that P2Y12 inhibitor de-escalation reduces adverse cardiovascular events after stenting for acute coronary syndrome (ACS). The trial selected candidates treated with P2Y12 inhibitors based on confirmed low platelet reactivity.

The study data were presented at TCT 2026 by Iñigo Lozano, MD, Head of Cardiology at Hospital Cabueñes in Gijon, Spain, and Associate Professor of Medicine at the University of Oviedo in Oviedo, Spain.

According to the TCT press release, previous research has shown that unguided de-escalation from prasugrel or ticagrelor to clopidogrel 1 month after ACS reduced net adverse cardiovascular events (NACE), with the largest apparent benefit observed in patients with very low platelet reactivity. The EPIC-17 VERONICA trial aimed to determine whether platelet reactivity testing could identify the best candidates for de-escalation.

TCT stated that from July 2021 to October 2024, 810 patients at 16 sites in Spain underwent platelet reactivity testing with the VerifyNow test (Werfen) between 30 and 40 days after discharge. All patients had undergone revascularization for ACS with a bioresorbable-polymer sirolimus-eluting stent and had been discharged on aspirin plus prasugrel or ticagrelor.

Of those patients tested, 78.6% (n = 637) had very low platelet reactivity (P2Y12 Reaction Units [PRU] ≤ 30) and were randomized 1:1 to either de-escalate to clopidogrel 75 mg daily after receiving a loading dose (n = 319) or continue their originally prescribed P2Y12 inhibitor for the remaining 11 months (n = 318). Patient and procedural characteristics were similar between the two groups.

As summarized in the TCT press release, the primary endpoint was NACE at 12 months, defined as cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or Bleeding Academic Research Consortium’s BARC 2 or higher bleeding. NACE occurred in 13.2% of patients who continued prasugrel or ticagrelor and 11.9% of those who de-escalated to clopidogrel (hazard ratio [HR], 0.88; 95% CI, 0.57-1.37; P = .737).

TCT advised that secondary endpoints included the individual components of the primary endpoint, definite stent thrombosis and unplanned revascularization. All three cardiovascular deaths occurred in the clopidogrel group.

Although MI rates were nonsignificantly lower with potent P2Y12 therapy, there were no significant differences between the ticagrelor/prasugrel and clopidogrel groups in MI (1.3% vs 2.8%; HR, 2.38; 95% CI, 0.73-7.78; P = .453) or bleeding (11.9% vs 8.8%; HR, 0.76; 95% CI, 0.46 to 1.24; P = .527).

Additionally, stroke was rare, with two events in each group, and there were no cases of definite stent thrombosis. Unplanned revascularization in the ticagrelor/prasugrel and clopidogrel groups occurred in 1.9% and 4.1%, respectively (HR, 2.88; 95% CI, 1.03 to 8.06; P = .1731), also nonsignificant after the adjustment for multiplicity.

“Event rates were lower than anticipated, limiting the trial’s power,” commented Dr. Lozano in the TCT press release. “Based on these results, routine platelet reactivity testing to guide P2Y12 inhibitor de-escalation rather than standard therapy cannot be recommended.”