Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: Systematic review and meta-analysis

D. Aradi, A. Komócsi, Matthew J. Price, Thomas Cuisset, Hasan Ari, Dobri Hazarbasanov, Dietmar Trenk, Dirk Sibbing, Marco Valgimigli, Laurent Bonello

Research output: Article

91 Citations (Scopus)

Abstract

Background: ADP-specific platelet function assays were shown to predict thrombotic events, and might be helpful to select candidates for more potent antiplatelet therapy. We aimed to determine the efficacy and safety of giving intensified antiplatelet therapy on the basis of platelet reactivity testing for patients undergoing percutaneous coronary intervention (PCI). Methods: Electronic databases were searched to find prospective, randomized trials that reported the clinical impact of using an intensified antiplatelet protocol (repeated loading or elevated maintenance doses of clopidogrel, prasugrel or glycoprotein IIb/IIIa inhibitor) on the basis of ADP-specific platelet reactivity testing (VerifyNow, Multiplate, VASP or light transmission aggregometry) compared to standard-dose clopidogrel. Evaluated efficacy measures included cardiovascular death, non-fatal myocardial infarction and definite/probable stent thrombosis (ST), while major bleeding events were recorded as safety endpoint. Results: Between 2008 and 2011, 10 clinical trials comprising 4213 randomized patients were identified. Compared to standard antiplatelet therapy, the intensified protocol was associated with a significant reduction in cardiovascular mortality, ST and myocardial infarction (p <0.01 for all). There was no difference in the rate of major bleeding events between intensified and standard groups (p = 0.44). Although the observed effects regarding mortality, ST and bleeding were not heterogeneous, meta-regression analysis revealed that the net clinical benefit of the intensified treatment significantly depended on the risk of ST with standard-dose clopidogrel (p = 0.023). Conclusion: Intensifying antiplatelet therapy on the basis of platelet reactivity testing reduces cardiovascular mortality and ST after PCI; however, the net benefit of this approach depends on the risk of ST with standard-dose clopidogrel.

Original languageEnglish
Pages (from-to)2140-2148
Number of pages9
JournalInternational Journal of Cardiology
Volume167
Issue number5
DOIs
Publication statusPublished - szept. 1 2013

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clopidogrel
Percutaneous Coronary Intervention
Stents
Meta-Analysis
Thrombosis
Blood Platelets
Safety
Hemorrhage
Adenosine Diphosphate
Mortality
Therapeutics
Myocardial Infarction
Platelet Glycoprotein GPIIb-IIIa Complex
Randomized Controlled Trials
Regression Analysis
Clinical Trials
Databases
Light

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention : Systematic review and meta-analysis. / Aradi, D.; Komócsi, A.; Price, Matthew J.; Cuisset, Thomas; Ari, Hasan; Hazarbasanov, Dobri; Trenk, Dietmar; Sibbing, Dirk; Valgimigli, Marco; Bonello, Laurent.

In: International Journal of Cardiology, Vol. 167, No. 5, 01.09.2013, p. 2140-2148.

Research output: Article

Aradi, D. ; Komócsi, A. ; Price, Matthew J. ; Cuisset, Thomas ; Ari, Hasan ; Hazarbasanov, Dobri ; Trenk, Dietmar ; Sibbing, Dirk ; Valgimigli, Marco ; Bonello, Laurent. / Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention : Systematic review and meta-analysis. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 5. pp. 2140-2148.
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T2 - Systematic review and meta-analysis

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AU - Komócsi, A.

AU - Price, Matthew J.

AU - Cuisset, Thomas

AU - Ari, Hasan

AU - Hazarbasanov, Dobri

AU - Trenk, Dietmar

AU - Sibbing, Dirk

AU - Valgimigli, Marco

AU - Bonello, Laurent

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N2 - Background: ADP-specific platelet function assays were shown to predict thrombotic events, and might be helpful to select candidates for more potent antiplatelet therapy. We aimed to determine the efficacy and safety of giving intensified antiplatelet therapy on the basis of platelet reactivity testing for patients undergoing percutaneous coronary intervention (PCI). Methods: Electronic databases were searched to find prospective, randomized trials that reported the clinical impact of using an intensified antiplatelet protocol (repeated loading or elevated maintenance doses of clopidogrel, prasugrel or glycoprotein IIb/IIIa inhibitor) on the basis of ADP-specific platelet reactivity testing (VerifyNow, Multiplate, VASP or light transmission aggregometry) compared to standard-dose clopidogrel. Evaluated efficacy measures included cardiovascular death, non-fatal myocardial infarction and definite/probable stent thrombosis (ST), while major bleeding events were recorded as safety endpoint. Results: Between 2008 and 2011, 10 clinical trials comprising 4213 randomized patients were identified. Compared to standard antiplatelet therapy, the intensified protocol was associated with a significant reduction in cardiovascular mortality, ST and myocardial infarction (p <0.01 for all). There was no difference in the rate of major bleeding events between intensified and standard groups (p = 0.44). Although the observed effects regarding mortality, ST and bleeding were not heterogeneous, meta-regression analysis revealed that the net clinical benefit of the intensified treatment significantly depended on the risk of ST with standard-dose clopidogrel (p = 0.023). Conclusion: Intensifying antiplatelet therapy on the basis of platelet reactivity testing reduces cardiovascular mortality and ST after PCI; however, the net benefit of this approach depends on the risk of ST with standard-dose clopidogrel.

AB - Background: ADP-specific platelet function assays were shown to predict thrombotic events, and might be helpful to select candidates for more potent antiplatelet therapy. We aimed to determine the efficacy and safety of giving intensified antiplatelet therapy on the basis of platelet reactivity testing for patients undergoing percutaneous coronary intervention (PCI). Methods: Electronic databases were searched to find prospective, randomized trials that reported the clinical impact of using an intensified antiplatelet protocol (repeated loading or elevated maintenance doses of clopidogrel, prasugrel or glycoprotein IIb/IIIa inhibitor) on the basis of ADP-specific platelet reactivity testing (VerifyNow, Multiplate, VASP or light transmission aggregometry) compared to standard-dose clopidogrel. Evaluated efficacy measures included cardiovascular death, non-fatal myocardial infarction and definite/probable stent thrombosis (ST), while major bleeding events were recorded as safety endpoint. Results: Between 2008 and 2011, 10 clinical trials comprising 4213 randomized patients were identified. Compared to standard antiplatelet therapy, the intensified protocol was associated with a significant reduction in cardiovascular mortality, ST and myocardial infarction (p <0.01 for all). There was no difference in the rate of major bleeding events between intensified and standard groups (p = 0.44). Although the observed effects regarding mortality, ST and bleeding were not heterogeneous, meta-regression analysis revealed that the net clinical benefit of the intensified treatment significantly depended on the risk of ST with standard-dose clopidogrel (p = 0.023). Conclusion: Intensifying antiplatelet therapy on the basis of platelet reactivity testing reduces cardiovascular mortality and ST after PCI; however, the net benefit of this approach depends on the risk of ST with standard-dose clopidogrel.

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KW - Clinical outcome

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