Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis
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...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-12-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/9/12/3907 |
| _version_ | 1797546061852573696 |
|---|---|
| author | Ann-Rong Yan Mark Naunton Gregory M. Peterson Israel Fernandez-Cadenas Reza Mortazavi |
| author_facet | Ann-Rong Yan Mark Naunton Gregory M. Peterson Israel Fernandez-Cadenas Reza Mortazavi |
| author_sort | Ann-Rong Yan |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T14:24:45Z |
| format | Article |
| id | doaj.art-e011ec4d7adb4975bbd9b17ef833c1e9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T14:24:45Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-e011ec4d7adb4975bbd9b17ef833c1e92023-11-20T23:09:10ZengMDPI AGJournal of Clinical Medicine2077-03832020-12-01912390710.3390/jcm9123907Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-AnalysisAnn-Rong Yan0Mark Naunton1Gregory M. Peterson2Israel Fernandez-Cadenas3Reza Mortazavi4School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, AustraliaSchool of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, AustraliaSchool of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, AustraliaStroke Pharmacogenomics and Genetics Group, Neurovascular Research Laboratory, Hospital de Sant Pau, 08041 Barcelona, SpainSchool of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, AustraliaBackground: 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.https://www.mdpi.com/2077-0383/9/12/3907antiplateletaspirinclopidogrelischemic strokeTIAplatelet function analysis |
| spellingShingle | Ann-Rong Yan Mark Naunton Gregory M. Peterson Israel Fernandez-Cadenas Reza Mortazavi 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 antiplatelet aspirin clopidogrel ischemic stroke TIA platelet function analysis |
| title | Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis |
| title_full | Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis |
| title_fullStr | Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis |
| title_short | Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis |
| title_sort | effectiveness of platelet function analysis guided aspirin and or clopidogrel therapy in preventing secondary stroke a systematic review and meta analysis |
| topic | antiplatelet aspirin clopidogrel ischemic stroke TIA platelet function analysis |
| url | https://www.mdpi.com/2077-0383/9/12/3907 |
| work_keys_str_mv | AT annrongyan effectivenessofplateletfunctionanalysisguidedaspirinandorclopidogreltherapyinpreventingsecondarystrokeasystematicreviewandmetaanalysis AT marknaunton effectivenessofplateletfunctionanalysisguidedaspirinandorclopidogreltherapyinpreventingsecondarystrokeasystematicreviewandmetaanalysis AT gregorympeterson effectivenessofplateletfunctionanalysisguidedaspirinandorclopidogreltherapyinpreventingsecondarystrokeasystematicreviewandmetaanalysis AT israelfernandezcadenas effectivenessofplateletfunctionanalysisguidedaspirinandorclopidogreltherapyinpreventingsecondarystrokeasystematicreviewandmetaanalysis AT rezamortazavi effectivenessofplateletfunctionanalysisguidedaspirinandorclopidogreltherapyinpreventingsecondarystrokeasystematicreviewandmetaanalysis |