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

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...

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Autores principales: Zhou, Yijiang, Wang, Yanwei, Wu, Yutao, Huang, Chaoyang, Yan, Hui, Zhu, Weiguo, Xu, Weiwei, Zhang, Li, Zhu, Jianhua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472866/
https://www.ncbi.nlm.nih.gov/pubmed/28619104
http://dx.doi.org/10.1186/s12872-017-0582-6
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author Zhou, Yijiang
Wang, Yanwei
Wu, Yutao
Huang, Chaoyang
Yan, Hui
Zhu, Weiguo
Xu, Weiwei
Zhang, Li
Zhu, Jianhua
author_facet Zhou, Yijiang
Wang, Yanwei
Wu, Yutao
Huang, Chaoyang
Yan, Hui
Zhu, Weiguo
Xu, Weiwei
Zhang, Li
Zhu, Jianhua
author_sort Zhou, Yijiang
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0582-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-54728662017-06-21 Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials Zhou, Yijiang Wang, Yanwei Wu, Yutao Huang, Chaoyang Yan, Hui Zhu, Weiguo Xu, Weiwei Zhang, Li Zhu, Jianhua BMC Cardiovasc Disord Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0582-6) contains supplementary material, which is available to authorized users. BioMed Central 2017-06-15 /pmc/articles/PMC5472866/ /pubmed/28619104 http://dx.doi.org/10.1186/s12872-017-0582-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhou, Yijiang
Wang, Yanwei
Wu, Yutao
Huang, Chaoyang
Yan, Hui
Zhu, Weiguo
Xu, Weiwei
Zhang, Li
Zhu, Jianhua
Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title_full Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title_fullStr Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title_full_unstemmed Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title_short Individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
title_sort individualized dual antiplatelet therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472866/
https://www.ncbi.nlm.nih.gov/pubmed/28619104
http://dx.doi.org/10.1186/s12872-017-0582-6
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