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Thromboelastography-Guided Antiplatelet Therapy for Patients with Ischemic Cerebrocardiovascular Diseases: A
Song He1, Quandan Tan2, Haifeng Shao3
1Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China, hesongsomething@outlook.com.
Insights
Thromboelastography (TEG)-guided antiplatelet therapy significantly reduces ischemic and bleeding events in patients with ischemic stroke or coronary artery disease. This approach offers improved efficacy and safety compared to standard treatments.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- The effectiveness of thromboelastography (TEG)-guided antiplatelet therapy for cerebrocardiovascular diseases remains unclear.
- This systematic review assesses TEG-guided therapy versus standard treatment in ischemic stroke (IS) and coronary artery disease (CAD) patients.
Purpose of the Study:
- To evaluate the efficacy and safety of TEG-guided antiplatelet therapy.
- To compare TEG-guided therapy with standard antiplatelet treatment in patients with IS or CAD.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
- Included 10 studies (4 RCTs, 6 observational) with 1,678 patients.
- Primary outcome: composite of ischemic and hemorrhagic events; Secondary outcomes: ischemic events, bleeding events.
Main Results:
- TEG-guided therapy significantly reduced composite ischemic and hemorrhagic events in RCTs (OR: 0.45) and pooled analyses (OR: 0.26).
- Pooled analysis showed significant reductions in ischemic events (OR: 0.28) and bleeding events (OR: 0.31) with TEG-guided therapy.
- All results demonstrated high statistical significance (p < 0.002).
Conclusions:
- TEG-guided antiplatelet therapy is effective and safe for patients with IS or CAD.
- Findings support using TEG to personalize antiplatelet therapy for cerebrocardiovascular diseases.
Introduction:
The effectiveness of thromboelastography (TEG)-guided antiplatelet therapy in patients with ischemic cerebrocardiovascular diseases is not well-established. This systematic review evaluates the efficacy and safety of TEG-guided antiplatelet therapy compared to standard treatment in patients with ischemic cerebrocardiovascular diseases.
Methods:
Randomized controlled trials (RCTs) and observational studies comparing TEG-guided antiplatelet therapy with standard therapy in patients suffering from ischemic stroke (IS) or coronary artery disease (CAD) were identified. The primary efficacy measure was a composite of ischemic and hemorrhagic events. Secondary efficacy measures included any ischemic events, while safety was assessed by the occurrence of bleeding events.
Results:
Ten studies involving 4 RCTs and 6 observational studies with a total of 1,678 patients were included. When considering a composite of ischemic and hemorrhagic events in RCTs, a significant reduction was observed in IS or CAD patients under TEG-guided therapy compared to standard therapy (OR: 0.45, 95% CI: 0.27-0.75, p = 0.002). After pooling RCTs and observational studies together, compared to standard antiplatelet therapy, TEG-guided therapy significantly reduced the risk of a composite of ischemic and hemorrhagic events (OR: 0.26, 95% CI: 0.19-0.37; p < 0.00001), ischemic events (OR: 0.28, 95% CI: 0.19-0.41; p < 0.00001), and bleeding events (OR: 0.31, 95% CI: 0.16-0.62; p = 0.0009) in patients with IS or CAD.
Conclusion:
TEG-guided antiplatelet therapy appears to be both effective and safe for patients with IS or CAD. These findings support the use of TEG testing to tailor antiplatelet therapy in individuals with ischemic cerebrocardiovascular diseases.
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