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Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke : systematic review and meta-analysis
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- Lim, Soon Tjin (author)
- Tallaght University Hospital,University College London
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- Thijs, Vincent (author)
- Austin Health,University of Melbourne
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- Murphy, Stephen J.X. (author)
- Tallaght University Hospital
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- Fernandez-Cadenas, Israel (author)
- Hospital de Sant Pau
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- Montaner, Joan (author)
- University Hospital Virgen del Rocío,Vall d'Hebron University Hospital
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- Offiah, Chika (author)
- Tallaght University Hospital
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- Marquardt, Lars (author)
- Asklepios Kliniken Hamburg GmbH
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- Kelly, Peter J. (author)
- University College Dublin
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- Bath, Philip M. (author)
- University of Nottingham
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- Lim, Su Yin (author)
- Taylor's University Malaysia
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- Ford, Gary A. (author)
- University of Oxford
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- Norrving, Bo (author)
- Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Stroke policy och kvalitetsregisterforskning,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Stroke Research Group,Lund University Research Groups,Stroke policy and quality register research
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- Cox, Dermot (author)
- Royal College of Surgeons in Ireland
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- Prodan, Calin I. (author)
- University of Oklahoma Health Sciences Center
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- Barber, Philip A. (author)
- University of Calgary
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- Werring, David J. (author)
- University College London
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- Perry, Richard (author)
- University College London
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- Zgaga, Lina (author)
- Trinity College Dublin
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- Dawson, Jesse (author)
- Glasgow Royal Infirmary,University of Glasgow
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- McCabe, Dominick J.H. (author)
- Trinity College Dublin,University College London,Tallaght University Hospital
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(creator_code:org_t)
- 2020-06-09
- 2020
- English 17 s.
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In: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 267:10, s. 3021-3037
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http://dx.doi.org/10...
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Ischaemic stroke
- Meta-analysis
- Platelet function/on-treatment platelet reactivity
- Systematic review
- Transient ischaemic attack
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Lim, Soon Tjin
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Thijs, Vincent
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Murphy, Stephen ...
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Fernandez-Cadena ...
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Montaner, Joan
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Offiah, Chika
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Marquardt, Lars
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Kelly, Peter J.
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Bath, Philip M.
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Lim, Su Yin
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Ford, Gary A.
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Norrving, Bo
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Cox, Dermot
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Prodan, Calin I.
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Barber, Philip A ...
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Werring, David J ...
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Perry, Richard
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Zgaga, Lina
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Dawson, Jesse
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McCabe, Dominick ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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Journal of Neuro ...
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Lund University