University of Pécs, Heart Institute, Pécs, Hungary.
Int J Cardiol. 2013 Sep 1;167(5):2140-8. doi: 10.1016/j.ijcard.2012.05.100. Epub 2012 Jun 15.
ADP-specific platelet function assays were shown to predict thrombotic events, and might be helpful to select candidates for more potent antiplatelet therapy. We aimed to determine the efficacy and safety of giving intensified antiplatelet therapy on the basis of platelet reactivity testing for patients undergoing percutaneous coronary intervention (PCI).
Electronic databases were searched to find prospective, randomized trials that reported the clinical impact of using an intensified antiplatelet protocol (repeated loading or elevated maintenance doses of clopidogrel, prasugrel or glycoprotein IIb/IIIa inhibitor) on the basis of ADP-specific platelet reactivity testing (VerifyNow, Multiplate, VASP or light transmission aggregometry) compared to standard-dose clopidogrel. Evaluated efficacy measures included cardiovascular death, non-fatal myocardial infarction and definite/probable stent thrombosis (ST), while major bleeding events were recorded as safety endpoint.
Between 2008 and 2011, 10 clinical trials comprising 4213 randomized patients were identified. Compared to standard antiplatelet therapy, the intensified protocol was associated with a significant reduction in cardiovascular mortality, ST and myocardial infarction (p<0.01 for all). There was no difference in the rate of major bleeding events between intensified and standard groups (p=0.44). Although the observed effects regarding mortality, ST and bleeding were not heterogeneous, meta-regression analysis revealed that the net clinical benefit of the intensified treatment significantly depended on the risk of ST with standard-dose clopidogrel (p=0.023).
Intensifying antiplatelet therapy on the basis of platelet reactivity testing reduces cardiovascular mortality and ST after PCI; however, the net benefit of this approach depends on the risk of ST with standard-dose clopidogrel.
ADP 特异性血小板功能检测可预测血栓事件，有助于选择更有效的抗血小板治疗的候选人群。我们旨在确定基于血小板反应性检测对接受经皮冠状动脉介入治疗（PCI）的患者进行强化抗血小板治疗的疗效和安全性。
检索电子数据库，寻找前瞻性、随机试验，这些试验报告了基于 ADP 特异性血小板反应性检测（VerifyNow、Multiplate、VASP 或光传输聚集测定法）使用强化抗血小板方案（重复负荷或升高氯吡格雷、普拉格雷或糖蛋白 IIb/IIIa 抑制剂的维持剂量）与标准剂量氯吡格雷相比对临床的影响。评估的疗效指标包括心血管死亡、非致死性心肌梗死和明确/可能的支架血栓形成（ST），而主要出血事件则作为安全性终点进行记录。
2008 年至 2011 年，确定了 10 项包含 4213 名随机患者的临床试验。与标准抗血小板治疗相比，强化方案与心血管死亡率、ST 和心肌梗死显著降低相关（所有 p<0.01）。强化组和标准组之间主要出血事件的发生率无差异（p=0.44）。尽管死亡率、ST 和出血的观察到的效果没有异质性，但荟萃回归分析显示，强化治疗的净临床获益显著取决于标准剂量氯吡格雷的 ST 风险（p=0.023）。
基于血小板反应性检测强化抗血小板治疗可降低 PCI 后心血管死亡率和 ST；然而，这种方法的净获益取决于标准剂量氯吡格雷的 ST 风险。
