Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis
Por:
Lim, ST, Thijs, V, Murphy, SJX, Fernandez-Cadenas, I, Montaner, J, Offiah, C, Marquardt, L, Kelly, PJ, Bath, PM, Lim, SY, Ford, GA, Norrving, B, Cox, D, Prodan, CI, Barber, PA, Werring, DJ, Perry, R, Zgaga, L, Dawson, J, McCabe, DJH
Publicada:
1 oct 2020
Ahead of Print:
1 jun 2020
Resumen:
Background The prevalence of ex vivo 'high on-treatment platelet reactivity (HTPR)' and its relationship with recurrent vascular events/outcomes in patients with ischaemic cerebrovascular disease (CVD) is unclear. Methods A systematic review and meta-analysis was performed in accordance with the PRISMA statement. MEDLINE, EMBASE and Cochrane Library were searched for completed manuscripts until May 2019 on TIA/ischaemic stroke patients, >= 18 years, treated with commonly-prescribed antiplatelet therapy, who had platelet function/reactivity testing and prospective follow-up data on recurrent stroke/TIA, myocardial infarction, vascular death or other cerebrovascular outcomes. Data were pooled using random-effects meta-analysis. Primary outcome was the composite risk of recurrent stroke/TIA, myocardial infarction or vascular death. Secondary outcomes were recurrent stroke/TIA, severe stroke (NIHSS > 16) or disability/impairment (modified Rankin scale >= 3) during follow-up. Results Antiplatelet-HTPR prevalence was 3-65% with aspirin, 8-56% with clopidogrel and 1.8-35% with aspirin-clopidogrel therapy. Twenty studies (4989 patients) were included in our meta-analysis. There was a higher risk of the composite primary outcome (OR 2.93, 95% CI 1.90-4.51) and recurrent ischaemic stroke/TIA (OR 2.43, 95% CI 1.51-3.91) in patients with vs. those without 'antiplatelet-HTPR' on any antiplatelet regimen. These risks were also more than twofold higher in patients with vs. those without 'aspirin-HTPR' and 'dual antiplatelet-HTPR', respectively. Clopidogrel-HTPR status did not significantly predict outcomes, but the number of eligible studies was small. The risk of severe stroke was higher in those with vs. without antiplatelet-HTPR (OR 2.65, 95% CI 1.00-7.01). Discussion Antiplatelet-HTPR may predict risks of recurrent vascular events/outcomes in CVD patients. Given the heterogeneity between studies, further prospective, multi-centre studies are warranted.
Filiaciones:
Lim, ST:
Tallaght Univ Hosp, Dept Neurol, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Tallaght Univ Hosp, Stroke Serv, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
UCL Queen Sq Inst Neurol, Dept Clin Neurosci, Royal Free Campus, London, England
Thijs, V:
Austin Hlth, Dept Neurol, Heidelberg, Vic, Australia
Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Heidelberg, Vic, Australia
Murphy, SJX:
Tallaght Univ Hosp, Dept Neurol, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Tallaght Univ Hosp, Stroke Serv, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Fernandez-Cadenas, I:
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Montaner, J:
Vall dHebron Inst Res VHIR, Neurovasc Res Lab, Barcelona, Spain
Univ Seville, CSIC, Hosp Univ Virgen del Rocio, Inst Biomed Seville,IBiS, Seville, Spain
Hosp Univ Virgen Macarena, Dept Neurol, Seville, Spain
Offiah, C:
Tallaght Univ Hosp, Dept Neurol, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Tallaght Univ Hosp, Stroke Serv, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Marquardt, L:
Asklepios Klin Wandsbek, Dept Neurol, Hamburg, Germany
Kelly, PJ:
Univ Coll Dublin, Mater Univ Hosp, Neurovasc Clin Sci Unit, Dublin, Ireland
Bath, PM:
Univ Nottingham, Stroke Trials Unit, Nottingham, England
Lim, SY:
Taylors Univ, Sch Med, Fac Hlth & Med Sci, Sungai Buloh, Malaysia
Ford, GA:
Univ Oxford, Oxford, England
Oxford Univ Hosp NHS Fdn Trust, Oxford, England
Norrving, B:
Lund Univ, Dept Clin Sci Lund, Neurol, Lund, Sweden
Cox, D:
Royal Coll Surgeons Ireland, Dept Mol & Cellular Therapeut, Dublin, Ireland
Irish Ctr Vasc Biol, Dublin, Ireland
Prodan, CI:
Univ Oklahoma, Hlth Sci Ctr, Dept Neurol, Norman, OK 73019 USA
VA Med Ctr, Norman, OK USA
Barber, PA:
Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
Werring, DJ:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Ctr Stroke Res, London, England
Perry, R:
UCL Queen Sq Inst Neurol, Dept Brain Repair & Rehabil, Ctr Stroke Res, London, England
Zgaga, L:
Univ Dublin, Trinity Coll Dublin, Dept Publ Hlth & Primary Care, Dublin, Ireland
Dawson, J:
Univ Glasgow, Div Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
Univ Glasgow, Inst Neurosci & Psychol, Glasgow, Lanark, Scotland
McCabe, DJH:
Tallaght Univ Hosp, Dept Neurol, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Tallaght Univ Hosp, Stroke Serv, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin, Ireland
Tallaght Univ Hosp, Vasc Neurol Res Fdn, Dept Neurol, Adelaide & Meath Hosp Dublin Incorp Natl Children, Dublin 24, Ireland
Irish Ctr Vasc Biol, Dublin, Ireland
UCL Queen Sq Inst Neurol, Dept Clin Neurosci, Royal Free Campus, London, England
Stroke Clin Trials Network Ireland, Dublin, Ireland
Trinity Coll Dublin, Acad Unit Neurol, Sch Med, Dublin, Ireland
Green Submitted, Green Accepted
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