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Platelet reactivity-adjusted antiplatelet therapy in patients with percutaneous coronary intervention: a

Zhenhua Xing1, Liang Tang1, Zhaowei Zhu1

  • 1a Department of Cardiovascular Medicine , The Second Xiangya Hospital, Central South University , Changsha , Hunan , China.

Platelets
|September 13, 2017
PubMed

Insights

Tailoring antiplatelet therapy based on platelet function monitoring did not reduce adverse events or bleeding in patients undergoing percutaneous coronary intervention (PCI). This approach failed to improve outcomes compared to conventional antiplatelet treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • High on-treatment platelet reactivity is a known risk factor for adverse events post-percutaneous coronary intervention (PCI).
  • The effectiveness of tailoring antiplatelet therapy based on platelet function monitoring remains controversial.

Purpose of the Study:

  • To evaluate the efficacy of platelet reactivity-adjusted antiplatelet therapy versus conventional therapy in patients undergoing PCI.
  • To assess the impact on mortality, major adverse cardiac events (MACE), and bleeding.

Main Methods:

  • A systematic search of PubMed, Embase, and Cochrane Central databases for relevant randomized trials.
  • Inclusion of six studies with 6347 patients comparing tailored vs. conventional antiplatelet therapy.
  • Pooled risk ratios (RRs) were derived using fixed-effect models for primary and safety end points.

Main Results:

  • Tailoring antiplatelet therapy did not significantly reduce all-cause mortality (RR: 0.89, 95% CI: 0.63-1.24).
  • No significant reduction was observed in MACE (RR: 1.02, 95% CI: 0.92-1.14), myocardial infarction (RR: 1.07, 95% CI: 0.95-1.21), or major bleeding events (RR: 0.79, 95% CI: 0.53-1.17).
  • Specific outcomes like cardiovascular death, stent thrombosis, and stroke/TIA also showed no significant benefit with tailored therapy.

Conclusions:

  • Platelet reactivity testing-guided antiplatelet therapy failed to demonstrate superiority over conventional treatment in reducing mortality, MACE, or bleeding in PCI patients.
  • Current evidence does not support routine tailoring of antiplatelet therapy based on platelet function monitoring in this population.

Keywords:
All-cause mortalityPlatelet reactivitymajor adverse cardiac events (MACE)major bleeding eventsmeta-analysispercutaneous coronary intervention (PCI)

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