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Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke:

Ann-Rong Yan1, Mark Naunton1, Gregory M Peterson1,2

  • 1School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia.

Journal of Clinical Medicine
|December 4, 2020
PubMed

Insights

Individualized antiplatelet therapy modification (ATM) guided by platelet function analysis (PFA) did not significantly reduce recurrent strokes or bleeding risk compared to standard care. More research is needed to confirm the effectiveness of PFA-guided ATM in preventing stroke recurrence.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Antiplatelet medications like aspirin and clopidogrel are standard post-thrombotic stroke or TIA care.
  • Recurrent strokes occur frequently despite antiplatelet therapy, indicating treatment failure.
  • Individualized antiplatelet therapy modification (ATM) based on platelet function analysis (PFA) is explored to improve outcomes.

Purpose of the Study:

  • To review and analyze existing evidence on the effectiveness of PFA-guided ATM in preventing recurrent strokes.
  • To evaluate the impact of PFA-guided ATM on bleeding risk and mortality.

Main Methods:

  • A systematic literature search was conducted across major databases (Medline, CINAHL, Embase, Web of Science, Cochrane) up to January 7, 2020.
  • Two observational studies, including 1136 patients, were included in the analysis.

Main Results:

  • PFA-based ATM showed no significant difference in preventing recurrent strokes (OR 1.05; 95% CI 0.69 to 1.58).
  • No significant differences were observed in overall bleeding risk (OR 1.39; 95% CI 0.92 to 2.10) or all-cause mortality (OR 1.19; 95% CI 0.62 to 2.29).
  • Subgroup analysis of aspirin non-responders also revealed insignificant differences in recurrent strokes, bleeding, and mortality.

Conclusions:

  • Current evidence does not support a significant benefit of PFA-guided ATM over standard antiplatelet therapy for preventing recurrent strokes or reducing bleeding risk.
  • Large, randomized controlled trials are necessary to investigate the efficacy of PFA-guided ATM.
  • Future research should address confounders like stroke subtypes, testing variations, adherence, and pharmacogenetics.
Abstract

Keywords:
TIAantiplateletantiplatelet therapy modificationaspirinclopidogrelhigh on-treatment platelet reactivityischemic strokeplatelet function analysissecondary stroke prevention

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