Yan, A-R and Naunton, M and Peterson, GM and Fernandez-Cadenas, I and Mortazavi, R, Effectiveness of platelet function analysis-guided aspirin and/or clopidogrel therapy in preventing secondary stroke: A systematic review and meta-analysis, Journal of Clinical Medicine, 9 pp. 1-15. ISSN 2077-0383 (2020) [Refereed Article]
Background: Antiplatelet medications such as aspirin and clopidogrel are used following thrombotic stroke or transient ischemic attack (TIA) to prevent a recurrent stroke. However, the antiplatelet treatments fail frequently, and patients experience recurrent stroke. One approach to lower the rates of recurrence may be the individualized antiplatelet therapies (antiplatelet therapy modification (ATM)) based on the results of platelet function analysis (PFA). This review was undertaken to gather and analyze the evidence about the effectiveness of such approaches.
Methods: We searched Medline, CINAHL, Embase, Web of Science, and Cochrane databases up to 7 January 2020.
Results: Two observational studies involving 1136 patients were included. The overall effects of PFA-based ATM on recurrent strokes (odds ratio (OR) 1.05; 95% confidence interval (CI) 0.69 to 1.58), any bleeding risk (OR 1.39; 95% CI 0.92 to 2.10) or death hazard from any cause (OR 1.19; 95% CI 0.62 to 2.29) were not significantly different from the standard antiplatelet therapy without ATM.
Conclusions: The two studies showed opposite effects of PFA-guided ATM on the recurrent strokes in aspirin non-responders, leading to an insignificant difference in the subgroup meta-analysis (OR 1.59; 95% CI 0.07 to 33.77), while the rates of any bleeding events (OR 1.04; 95% CI 0.49 to 2.17) or death from any cause (OR 1.17; 95% CI 0.41 to 3.35) were not significantly different between aspirin non-responders with ATM and those without ATM. There is a need for large, randomized controlled trials which account for potential confounders such as ischemic stroke subtypes, technical variations in the testing protocols, patient adherence to therapy and pharmacogenetic differences.
|Item Type:||Refereed Article|
|Keywords:||antiplatelet, aspirin, clopidogrel, ischemic stroke, TIA, platelet function analysis, antiplatelet therapy modification, secondary stroke prevention, high on-treatment platelet reactivity|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Pharmacology and pharmaceutical sciences|
|Research Field:||Clinical pharmacology and therapeutics|
|Objective Group:||Clinical health|
|Objective Field:||Efficacy of medications|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
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