Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischa
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ORIGINAL COMMUNICATION
Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta‑analysis Soon Tjin Lim1,2,24 · Vincent Thijs4,5 · Stephen J. X. Murphy1,2 · Israel Fernandez‑Cadenas6 · Joan Montaner7,8 · Chika Offiah1,2 · Lars Marquardt9 · Peter J. Kelly10,25 · Philip M. Bath11 · Su‑Yin Lim12 · Gary A. Ford13,14 · Bo Norrving15 · Dermot Cox16,17 · Calin I. Prodan18 · Philip A. Barber19 · David J. Werring20 · Richard Perry20 · Lina Zgaga21 · Jesse Dawson22,23 · Dominick J. H. McCabe1,2,3,17,24,25,26 Received: 28 April 2020 / Revised: 15 May 2020 / Accepted: 19 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Platelet function/on-treatment platelet reactivity · Transient ischaemic attack · Ischaemic stroke · Systematic review · Meta-analysis
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-09932-y) contains supplementary material, which is available to authorize
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