Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis
Por:
Yan, AR, Naunton, M, Peterson, GM, Fernandez-Cadenas, I, Mortazavi, R
Publicada:
1 dic 2020
Resumen:
Background: Antiplatelet medications such as aspirin and clopidogrel are used following thrombotic stroke or transient ischemic attack (TIA) to prevent a recurrent stroke. However, the antiplatelet treatments fail frequently, and patients experience recurrent stroke. One approach to lower the rates of recurrence may be the individualized antiplatelet therapies (antiplatelet therapy modification (ATM)) based on the results of platelet function analysis (PFA). This review was undertaken to gather and analyze the evidence about the effectiveness of such approaches. Methods: We searched Medline, CINAHL, Embase, Web of Science, and Cochrane databases up to 7 January 2020. Results: Two observational studies involving 1136 patients were included. The overall effects of PFA-based ATM on recurrent strokes (odds ratio (OR) 1.05; 95% confidence interval (CI) 0.69 to 1.58), any bleeding risk (OR 1.39; 95% CI 0.92 to 2.10) or death hazard from any cause (OR 1.19; 95% CI 0.62 to 2.29) were not significantly different from the standard antiplatelet therapy without ATM. Conclusions: The two studies showed opposite effects of PFA-guided ATM on the recurrent strokes in aspirin non-responders, leading to an insignificant difference in the subgroup meta-analysis (OR 1.59; 95% CI 0.07 to 33.77), while the rates of any bleeding events (OR 1.04; 95% CI 0.49 to 2.17) or death from any cause (OR 1.17; 95% CI 0.41 to 3.35) were not significantly different between aspirin non-responders with ATM and those without ATM. There is a need for large, randomized controlled trials which account for potential confounders such as ischemic stroke subtypes, technical variations in the testing protocols, patient adherence to therapy and pharmacogenetic differences.
Filiaciones:
Yan, AR:
Univ Canberra, Fac Hlth, Sch Hlth Sci, Canberra, ACT 2617, Australia
Naunton, M:
Univ Canberra, Fac Hlth, Sch Hlth Sci, Canberra, ACT 2617, Australia
Peterson, GM:
Univ Canberra, Fac Hlth, Sch Hlth Sci, Canberra, ACT 2617, Australia
Univ Tasmania, Sch Pharm & Pharmacol, Hobart, Tas 7000, Australia
Fernandez-Cadenas, I:
Hosp Santa Creu & Sant Pau, Stroke Pharmacogen & Genet Grp, Neurovasc Res Lab, Barcelona 08041, Spain
Mortazavi, R:
Univ Canberra, Fac Hlth, Sch Hlth Sci, Canberra, ACT 2617, Australia
Univ Canberra, Fac Hlth, Prehab Act Canc Exercise Survivorship Res Grp, Canberra, ACT 2617, Australia
Green Published, Green Submitted, gold
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