University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA.
J Neurointerv Surg. 2019 Nov;11(11):1123-1128. doi: 10.1136/neurintsurg-2019-014765. Epub 2019 Apr 20.
Platelet function testing prior to flow diversion procedures, although initially heavily debated, has seen a substantial increase in its adoption to assess the risk of operative and perioperative thrombotic and hemorrhagic events. This meta-analysis was conducted to assess platelet function testing, particularly the VerifyNow Platelet Reactivity Unit (PRU) assay, for a relationship between the reported assay PRU value and thrombotic and hemorrhagic events.
The currently available literature (2013-2018) was surveyed with PubMed and Google Scholar searches. Included studies were those for which there were at least 30 cases during the study period, for which VerifyNow platelet reactivity unit values were obtained prior to the procedures and for which intraoperative and perioperative adverse events were noted. PRU value cut-offs ranging from >200 to >240 comprised the hyporesponse group while values ranging from <60 to <70 comprised the hyper-response group. The data were subject to statistical analysis to assess the relationship between PRU values and thrombotic and hemorrhagic events. The collected data were subsequently statistically analyzed to assess for publication bias.
The searches yielded 27 studies, of which 12 met the inclusion criteria for the meta-analysis. The meta-analysis included data from 1464 reported Pipeline cases. The study included 273 men and 1177 women with a mean age across the analyzed procedures of 58 years (range 25-85). After loading with antiplatelet medications, preprocedural platelet hyper-responsiveness was associated with a greater incidence of hemorrhagic events with an increased absolute risk of 12%, but showed no relationship with thrombotic events. Preprocedural platelet hyporesponsiveness was associated with a greater incidence of thrombotic events with an absolute risk of 15%, but showed no relationship with hemorrhagic events.
VerifyNow PRU values that correspond to platelet hyporesponse or hyper-response to dual antiplatelet therapy are associated with a higher risk of thrombotic and hemorrhagic events, respectively. Thus, the PRU value may offer some predictive value for these events.
尽管最初对血流导向装置术前的血小板功能检测存在较大争议，但该检测方法在评估手术和围手术期血栓形成和出血风险方面的应用已经大幅增加。本荟萃分析旨在评估血小板功能检测，特别是VerifyNow 血小板反应单位（PRU）检测，以了解报告的检测 PRU 值与血栓形成和出血事件之间的关系。
通过 PubMed 和 Google Scholar 检索，调查了 2013 年至 2018 年期间的现有文献。纳入的研究为在研究期间至少有 30 例患者、在手术前获得 VerifyNow 血小板反应单位值且记录了术中及围手术期不良事件的研究。PRU 值截断值>200>240 为低反应组，而<60<70 为高反应组。对数据进行了统计学分析，以评估 PRU 值与血栓形成和出血事件之间的关系。随后对收集的数据进行了统计学分析，以评估发表偏倚。
搜索结果共 27 项研究，其中 12 项符合荟萃分析的纳入标准。荟萃分析纳入了 1464 例报告的 Pipeline 病例数据。该研究纳入了 273 名男性和 1177 名女性，在分析的所有手术中，平均年龄为 58 岁（范围 25-85 岁）。在加载抗血小板药物后，术前血小板高反应性与出血事件的发生率增加相关，绝对风险增加 12%，但与血栓事件无关。术前血小板低反应性与血栓事件的发生率增加相关，绝对风险增加 15%，但与出血事件无关。
VerifyNow PRU 值对应于双重抗血小板治疗的血小板低反应或高反应与血栓形成和出血事件的风险增加分别相关。因此，PRU 值可能对这些事件有一定的预测价值。
Zotero 插件