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Meta-Analysis
. 2014 May;12(5):736-47.
doi: 10.1111/jth.12538.

Platelet-reactivity tests identify patients at risk of secondary cardiovascular events: a systematic review and meta-analysis

P P Wisman  1 , M Roest, F W Asselbergs, P G de Groot, F L Moll, Y van der Graaf, G J de Borst
Affiliations
Free article
Meta-Analysis

Platelet-reactivity tests identify patients at risk of secondary cardiovascular events: a systematic review and meta-analysis

P P Wisman et al. J Thromb Haemost. 2014 May.
Free article

Abstract

Background: Antiplatelet therapy is the standard treatment for the prevention of cardiovascular events (CVEs). High on-treatment platelet reactivity (HPR) is a risk factor for secondary CVEs in patients prescribed aspirin and/or clopidogrel. The present review and meta-analysis was aimed at assessing the ability of individual platelet-function tests to reliably identify patients at risk of developing secondary CVEs.

Methods and results: A systematic literature search was conducted to identify studies on platelet-reactivity measurements and CVEs. The main inclusion criteria were: (i) prospective study design; (ii) study medication, including aspirin and/or clopidogrel; and (iii) a platelet-function test being performed at baseline, before follow-up started. Of 3882 identified studies, 102 (2.6%; reporting on 44 098 patients) were included in the meta-analysis. With regard to high on-aspirin platelet reactivity (HAPR), 22 different tests were discussed in 55 studies (22 441 patients). Pooled analysis showed that HAPR was diagnosed in 22.2% of patients, and was associated with an increased CVE risk (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77-2.47). Eleven HAPR tests independently showed a significantly increased CVE risk in patients with HAPR as compared with those with normal on-aspirin platelet reactivity. As regards high on-clopidogrel platelet reactivity (HCPR), 59 studies (34 776 patients) discussed 15 different tests, and reported that HCPR was present in 40.4% of patients and was associated with an increased CVE risk (RR 2.80; 95% CI 2.40-3.27). Ten tests showed a significantly increased CVE risk.

Conclusions: Patients with HPR are suboptimally protected against future cardiovascular complications. Furthermore, not all of the numerous platelet tests proved to be able to identify patients at increased cardiovascular risk.

Keywords: aspirin; clopidogrel; meta-analysis; platelets; thrombosis.

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