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Intensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response: A

Lei Xu, Xiao-Wei Hu, Shu-Hua Zhang

  • 1Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China.

Chinese Medical Journal
|April 12, 2016
PubMed

Insights

Intensified antiplatelet treatment (IAT) for patients with clopidogrel low response (CLR) after percutaneous coronary intervention (PCI) significantly reduces cardiovascular death, myocardial infarction, and stent thrombosis without increasing bleeding risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Clopidogrel low response (CLR) is a significant risk factor for adverse events post-percutaneous coronary intervention (PCI).
  • Intensified antiplatelet treatment (IAT) guided by platelet function assays is a potential strategy to manage CLR.
  • The clinical benefit of IAT in patients with CLR remains controversial.

Purpose of the Study:

  • To evaluate the efficacy and safety of IAT guided by platelet function assays in patients with CLR undergoing PCI.
  • To determine if IAT improves clinical outcomes compared to conventional antiplatelet therapy.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Databases searched included PubMed, Cochrane Library, and Chinese Medical Journal Network up to September 2014.
  • Data from 13 RCTs involving 5111 patients were analyzed using conventional and cumulative meta-analysis.

Main Results:

  • IAT significantly reduced the incidence of cardiovascular death, nonfatal myocardial infarction (MI), and stent thrombosis (ST) (RR = 0.45, P < 0.000,01).
  • The incidence of bleeding events was comparable between the IAT and conventional antiplatelet treatment groups (RR = 1.05, P = 0.65).
  • Follow-up periods ranged from 1 to 12 months across the included trials.

Conclusions:

  • IAT guided by platelet function assays is effective in reducing major adverse cardiovascular events in patients with CLR undergoing PCI.
  • IAT does not appear to increase the risk of bleeding complications.
  • This strategy offers a promising approach to optimize antiplatelet therapy in this patient population.
Abstract

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