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- Title
Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials.
- Authors
Yijiang Zhou; Yanwei Wang; Yutao Wu; Chaoyang Huang; Hui Yan; Weiguo Zhu; Weiwei Xu; Li Zhang; Jianhua Zhu; Zhou, Yijiang; Wang, Yanwei; Wu, Yutao; Huang, Chaoyang; Yan, Hui; Zhu, Weiguo; Xu, Weiwei; Zhang, Li; Zhu, Jianhua
- Abstract
<bold>Background: </bold>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).<bold>Methods: </bold>Electronic databases were searched for randomized control trials that reported the clinical outcomes of using an intensified antiplatelet protocol with P2Y12 receptor inhibitor comparing with standard maintenance dose of clopidogrel on the basis of platelet function testing. Clinical endpoints were assessed.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
CLOPIDOGREL; PLATELET aggregation inhibitors; PERCUTANEOUS coronary intervention; META-analysis; RANDOMIZED controlled trials; MYOCARDIAL revascularization; DRUG efficacy; CORONARY heart disease prevention; DRUG dosage; TREATMENT of acute coronary syndrome; BLOOD platelets; BLOOD platelet aggregation; CARDIOVASCULAR system; CELL receptors; COMBINATION drug therapy; CHI-squared test; CLINICAL trials; COMPARATIVE studies; CORONARY disease; DRUG resistance; DRUGS; HEMORRHAGE; RESEARCH methodology; MEDICAL care; MEDICAL cooperation; NEUROTRANSMITTERS; RESEARCH; TICLOPIDINE; EVALUATION research; TREATMENT effectiveness; PREDICTIVE tests; ACUTE coronary syndrome; PLATELET function tests; ODDS ratio; BLOOD; DIAGNOSIS
- Publication
BMC Cardiovascular Disorders, 2017, Vol 17, p1
- ISSN
1471-2261
- Publication type
journal article
- DOI
10.1186/s12872-017-0582-6