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

Abstract

Background: 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). Methods: Electronic databases were searched for randomized control trials that reported the clinical outcomes of using an intensified antiplatelet protocol with P2Y 12 receptor inhibitor comparing with standard maintenance dose of clopidogrel on the basis of platelet function testing. Clinical endpoints were assessed. Results: 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. Conclusions: 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.

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

“…For HPR patients, a personalized antiplatelet treatment with selective intensification of P2Y12 receptor inhibition has been investigated in several previous studies . In the ISAR‐HPR registry, retreatment with clopidogrel, switch to prasugrel, and reassessment of platelet function were associated with a significant decrease in the incidence of adverse events when compared to historical controls .…”

“…34 For HPR patients, a personalized antiplatelet treatment with selective intensification of P2Y12 receptor inhibition has been investigated in several previous studies. 7,8,35,36 In the ISAR-HPR registry, retreatment with clopidogrel, switch to prasugrel, and reassessment of platelet function were associated with a significant decrease in the incidence of adverse events when compared to historical controls. 36 The CREATIVE randomized study indicated that the intensified antiplatelet strategy with adjunctive use of cilostazol significantly improved clinical outcomes of patients with low response to clopidogrel.…”

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

“…These latter RCTs showed no benefits to the use of personalized antiplatelet regimen based on PFTs. A meta-analysis of 13 RCTs and more than 7000 patients showed that a personalized, intensified antiplatelet regimen, based on a PFT, decreased the incidence of cardiovascular events without increasing the risk of bleeding [65]. Potential biases in some trials, together with some statistical heterogeneity, may mitigate this interpretation.…”

Individualized intensified antiplatelet therapy based on platelet reactivity testing reduces the incidence of cardiovascular events in patients undergoing percutaneous coronary intervention

“…We performed a thorough search of the literature that revealed a substantial number of recent studies demonstrating the safety and efficacy of PFT guidance in patients undergoing percutaneous coronary intervention (PCI) (2-5). A recent meta-analysis that included 13 clinical studies and a total of 7290 patients concluded that the PFT-based intensified protocol is associated with a significant reduction in major adverse cardiovascular events, stent thrombosis, cardiovascular death, and target vessel revascularization without increasing the risk of major bleeding (2).…”

“…A recent meta-analysis that included 13 clinical studies and a total of 7290 patients concluded that the PFT-based intensified protocol is associated with a significant reduction in major adverse cardiovascular events, stent thrombosis, cardiovascular death, and target vessel revascularization without increasing the risk of major bleeding (2). …”