Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials

• Published in: BMC cardiovascular disorders 2017-06, Vol.17 (1), p.157-157, Article 157
• Main Authors: Zhou, Yijiang, Wang, Yanwei, Wu, Yutao, Huang, Chaoyang, Yan, Hui, Zhu, Weiguo, Xu, Weiwei, Zhang, Li, Zhu, Jianhua
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Acute coronary syndromes; Analysis; Angioplasty; Antiplatelet therapy; Balloon angioplasty; Bias; Bleeding; Blood platelets; Blood Platelets - drug effects; Blood Platelets - metabolism; Cardiovascular diseases; Care and treatment; Chi-Square Distribution; Clinical outcomes; Clinical trials; Clopidogrel; Complications and side effects; Confidence intervals; Coronary Thrombosis - blood; Coronary Thrombosis - diagnosis; Coronary Thrombosis - mortality; Coronary Thrombosis - prevention & control; Diabetes; Dosage and administration; Drug dosages; Drug Resistance; Drug Therapy, Combination; Dual antiplatelet therapy; Heart attacks; Hemorrhage - chemically induced; High on-treatment atelet reactivity; Humans; Implants; Intervention; Meta-analysis; Methods; Odds Ratio; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Physiological aspects; Platelet Aggregation - drug effects; Platelet aggregation inhibitors; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Platelet Function Tests; Platelets; Precision Medicine; Predictive Value of Tests; Purinergic P2Y Receptor Antagonists - administration & dosage; Purinergic P2Y Receptor Antagonists - adverse effects; Randomized Controlled Trials as Topic; Receptors, Purinergic P2Y12 - blood; Receptors, Purinergic P2Y12 - drug effects; Risk Factors; Stents; Studies; Thrombosis; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Treatment Outcome; Variance analysis
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-017-0582-6

High on-treatment platelet reactivity (HPR) represents a strong risk factor for thrombotic events after PCI. We aim to evaluate the efficacy and safety of individualizing intensified dual antiplatelet therapy (DAPT) in PCI-treated patients with HPR based on platelet function testing (PFT). Electronic databases were searched for randomized control trials that reported the clinical outcomes of using an intensified antiplatelet protocol with P2Y receptor inhibitor comparing with standard maintenance dose of clopidogrel on the basis of platelet function testing. Clinical endpoints were assessed. From 2005 to 2016, thirteen clinical studies comprising 7290 patients were included for analysis. Compared with standard antiplatelet therapy with clopidogrel, the intensified protocol based on platelet function testing was associated with a significant reduction in major adverse cardiovascular events (RR:0.55, 95% CI: 0.36-0.84, p = 0.005), cardiovascular death (RR:0.60, 95% CI: 0.38-0.96, p = 0.03), stent thrombosis (RR:0.58, 95% CI: 0.36-0.93, p = 0.02) and target vessel revascularization (RR:0.33, 95% CI: 0.14-0.76, p = 0.009). No significant difference was found in the rate of bleeding events between intensified and standard protocol. Compared with standard clopidogrel therapy, individualized intensified antiplatelet therapy on the basis of platelet reactivity testing reduces the incidence of cardiovascular events in patient undergoing PCI, without increasing the risk of bleeding.