Use of the PFA-100™ closure time to predict cardiovascular events in aspirin-treated cardiovascular patients: a systematic review and meta-analysis

Abstract

To cite this article: Reny J-L, de Moerloose P, Dauzat M, Fontana P. Use of the PFA-100 TM closure time to predict cardiovascular events in aspirintreated cardiovascular patients: a systematic review and meta-analysis. J Thromb Haemost 2008; 6: 444-50.Summary. Background: PFA-100 TM is a point-of-care assay that evaluates platelet reactivity in high-shear-stress conditions by measuring the closure time (CT) of a membrane aperture. When determined with a collagen/epinephrine cartridge (CEPI), the CT is usually prolonged by aspirin. Studies of the predictive value of a short PFA-100 TM CT CEPI for ischemic events in aspirin-treated patients have given variable results. Objectives: To conduct a systematic review and metaanalysis of studies on the clinical predictive value of a short PFA-100 TM CT CEPI in aspirin-treated cardiovascular patients. Patients and methods: Relevant studies were identified by scanning electronic databases. Studies were selected if they included aspirin-treated patients with symptomatic atherosclerosis, measured the PFA-100 TM CT CEPI , used a CT cut-off value to define aspirin ÔrespondersÕ and Ônon-respondersÕ, and reported ischemic events. Results: We selected seven nonprospective studies (1466 patients) and eight prospective studies (1227 patients). In non-prospective studies, the PFA-100 TM CT CEPI was performed after the ischemic clinical endpoint, and a publication bias was identified. In prospective studies, the global odds ratio (OR) for the recurrence of an ischemic event in Ôaspirin non-respondersÕ relative to Ôaspirin respondersÕ was 2.1 [95% confidence interval (CI) 1.4-3.4, P < 0.001]. Pooled analysis with a random effect model revealed no heterogeneity (Q Cochran P = 0.36 and I 2 = 9.4%). Conclusions: A short PFA-100 TM CT CEPI is associated with increased recurrence of ischemic events in aspirintreated cardiovascular patients. This finding needs to be confirmed in stable ischemic patients, and the PFA-100 TM CT CEPI cut-off needs to be refined in these patients.

Variability of non-response to aspirin in patients with peripheral arterial occlusive disease during long-term follow-up

“…Unfortunately, the total number of cases in our study is too small to answer the question of whether adverse patient outcomes can be predicted through detection of persistent or intermittent residual platelet function by means of LTA or on the PFA-100® system. In recent years, several studies have investigated if laboratory-assessed non-responsiveness to ASA is predictive of future ischemic vascular events, primarily in the case of patients with IHD or cerebrovascular disease [28][29][30]. The authors confirmed that residual platelet function in ASA-treated patients was associated with an unfavorable outcome.…”

Assessment of clopidogrel non-response by the PFA-100® system using the new test cartridge INNOVANCE® PFA P2Y

“…Several studies have been published in recent years suggesting an association of a normal CEPI-CT in aspirin-treated patients with an unfavorable cardiovascular outcome; the results of these studies have been summarized in two recent meta-analyses [38,39]. In addition, on the basis of prospective studies, there is now evidence that high residual platelet reactivity determined by ADP-induced LTA predicts future ischemic events in patients on dual antiplatelet therapy [5][6][7][8][9].…”

Laboratory Aspirin Resistance and the Risk of Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease on Confirmed Aspirin Adherence

“…Non-adherence to aspirin is thought to be an important cause of aspirin resistance [12][13][14] , and patients who are non-adherent to aspirin therapy suffer from a significantly elevated number of cardiovascular events. In previous metaanalyses of the relationship between aspirin resistance and adverse events, adherence to aspirin was not considered as a selective criterion [7][8][9][10][11] . Furthermore, relevant prospective studies on this issue have been reported since the publication of these meta-analyses.…”

“…However, in some patients, aspirin fails to inhibit platelets, as determined on ex vivo laboratory tests, in a phenomenon termed laboratory aspirin resistance 5,6) . Studies investigating the association between aspirin resistance and clinical outcomes have been reviewed in several meta-analyses exploring the potential increased risk of adverse events in aspirin-resistant patients [7][8][9][10][11] . events ("event ＊ " or "consequence ＊ " or "outcome ＊ " or "recurren ＊ " or "prognosis") and the specified population ("coronary artery disease" or "coronary heart disease" or "ischemic heart disease" or "angina" or "myocardial infarction" or "acute coronary syndrome ＊ ").…”