Abstract
BackgroundHigh 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).MethodsElectronic 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.ResultsFrom 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.ConclusionsCompared 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.
Highlights
High on-treatment platelet reactivity (HPR) represents a strong risk factor for thrombotic events after percutaneous coronary interventions (PCI)
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 antagonist represents the standard of care in patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary interventions (PCI) [1]
All studies used P2Y12 antagonist for intensified antiplatelet regime: two studies administered repeated loading dose of 600 mg clopidogrel [8, 9]; seven studies increased maintenance dose of clopidogrel [11, 23,24,25,26,27,28]; two studies used repeated loading dose of 600 mg clopidogrel combined with increased maintenance dose of clopidogrel or prasugrel [29, 30]; another two studies used prasugrel for loading and maintenance [13, 14]
Summary
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). Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 antagonist represents the standard of care in patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary interventions (PCI) [1]. A concerning issue is that wide interindividual variability exists among P2Y12 antagonist, Zhou et al BMC Cardiovascular Disorders (2017) 17:157 randomized trials failed to demonstrate similar improvements in clinical outcomes with a tailored antiplatelet therapy based on platelet function monitoring [11,12,13,14]. We performed meta-analysis on previous studies to evaluate the clinical efficacy and safety of individualized intensification of antiplatelet therapy with P2Y12 inhibitors versus standard dose clopidogrel on the basis of platelet function testing(PFT) in patients undergoing PCI
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