Table 3.
Clinical outcome with different antiplatelet therapies and regimens
| Authors (year) | Study design | Population | No. studies (no. patients) | Drug and/or intervention | Lab method | Clinical outcome Risk Ratio (RR) or Odds ratio (OR) with 95% CI are mainly given |
|---|---|---|---|---|---|---|
| Zhou, Y. et al. (2017) [18] | Meta-analysis of RCTs | Patients with CAD undergoing PCI | 13 (7290) | CAT vs. IAT based on platelet function testing | VASP, VN, LTA, Multiplate | Testing-guided IAT was associated with a significant reduction in MACE [RR: 0.55 (0.36, 0.84), p = 0.005], CV death [RR: 0.60 (0.38–0.96), p = 0.03], ST [RR: 0.58 (0.36, 0.93), p = 0.02] and TVR [RR: 0.33 (0.14–0.76), p = 0.009] compared to CAT. No significant difference in rate of bleeding events. |
| Xu, L. et al. (2016) [19] | Meta-analysis of RCTs | Patients with CAD undergoing PCI | 13 (5111) | CAT vs. IAT based on platelet function testing | VASP, VN, LTA, Multiplate, TEG | The incidences of CV death, nonfatal MI, and stent thrombosis were significantly lower in the IAT group than in the CAT group [RR: 0.45, (0.36, 0.57), p < 0.00001], whereas bleeding was similar between the two groups [RR: 1.05 (0.86, 1.27), p = 0.65]. |
| Reny, J. et al. (2016) [20] | Meta-analysis of prospective cohorts and RCTs | Patients with symptomatic atherothrombosis | 13 (6478) | Clopidogrel | LTA | The strength of the association between PR and the risk of MACE increased significantly (p = 0.04) with the number of risk factors present (age > 75 years, ACS at inclusion, diabetes, and hypertension). No association was detected in patients with no risk factor (p = 0.48). |
| Ma, W. et al. (2015) [21] | Meta-analysis of RCTs | Patients undergoing PCI | 17 (4822) |
CAT vs. IAT with and without platelet function testing. |
VASP, VN, LTA, Multiplate | IAT was generally associated with a significant reduction in the risk of MACE [OR: 0.52 (0.39, 0.71), p < 0.0001]. The subgroup with HPR did also benefit from IAT compared to CAT [OR: 0.54 (0.38, 0.77), p = 0.0007]. The observed benefits were mainly attributed to treatment-associated reduction in ST [OR: 0.43 (0.23, 0.78), p = 0.006] and TVR [OR: 0.38 (0.20, 0.74), p = 0.004]. No difference in the rate of major/minor bleeding event between IAT or CAT [OR: 0.80 (0.56, 1.13), p = 0.21]. |
| Lin, L. et al. (2015) [22] | Meta-analysis of RCTs | Patients undergoing PCI | 8 (3865) |
CAT vs. IAT in patients with HPR |
VASP, VN, LTA, Multiplate | In patients with HPR, IAT significantly reduced the risk of MACE/MACCE [RR: 0.59 (0.39, 0.88), p = 0.01], CV death [RR: 0.33, (0.12, 0.97), p = 0.04], ST [RR: 0.43 (0.20, 0.92), p = 0.03], and TVR [RR 0.31 (0.10, 0.93), p = 0.04], without increasing major bleeding [RR 0.75 (0.43, 1.31), p = 0.31] compared with CAT. |
| D’Ascenzo, F. et al. (2014) [23] | Meta-analysis | Patients with CAD | 26 (28178) | Aspirin vs. clopidogrel | VN, LTA, Multiplate, TEG, | HPR was reported in 29% of patients on clopidogrel. HPR was not an independent prognostic indicator of adverse cardiac events in patients with either stable and unstable coronary disease for adverse cardiac events. |
| Chen, J. et al. (2013) [24] | Meta-analysis | Population with ACS | 8 (605) | Clopidogrel with and without PPI | VASP, VN, Multiplate | Compared to clopidogrel treatment alone, patients who received both a PPI and clopidogrel had less of a decrease in the PRI [WMD: 8.18 (6.81, 9.56), p < 0.00001], less ADP–induced platelet aggregation inhibition [WMD: 7.28 (2.44, 12.11), p = 0.003], higher PRU [WMD: 40.58 (19.31, 61.86), p = 0.0002], and higher risks of clopidogrel resistance [OR: 2.49 (1.49, 4.14), p = 0.0005]. However, no significant differences for the incidences of MACE were found. |
BMI body mass index, CAT conventional antiplatelet therapy, CV cardiovascular, HPR high platelet reactivity, IAT intensified antiplatelet therapy, LD loading dose, LPR low platelet reactivity, LTA light transmission aggregometry, MACCE major adverse cardiac and cerebrovascular events, MACE major adverse cardiovascular events, MI myocardial infarction, MD maintenance dose, MPA maximal platelet aggregation, OR odds ratio, PPI protein pump inhibitors, PR platelet reactivity, PRI platelet reactivity index, PRU platelet reactivity units, RCTs randomized controlled trials, RR relative risk, SD standard dose, ST stent thrombosis, TEG thrombelastography, TVR target vessel revascularization, VASP Vasodilator stimulated phosphoprotein, VN VerifyNow-P2Y12, WMD weighted mean differenc