Increased risk of adverse events in patients with low-on clopidogrel platelet reactivity after percutaneous coronary intervention: A systematic review and meta-analysis.
acute coronary syndrome
bleeding risk
clopidogrel
low platelet reactivity
percutaneous coronary intervention
Journal
Cardiology journal
ISSN: 1898-018X
Titre abrégé: Cardiol J
Pays: Poland
ID NLM: 101392712
Informations de publication
Date de publication:
2023
2023
Historique:
received:
11
03
2021
accepted:
27
06
2021
medline:
20
6
2023
pubmed:
7
8
2021
entrez:
6
8
2021
Statut:
ppublish
Résumé
Clinical evidence has been controversial regarding the influence of low platelet reactivity (LPR), ischemic and bleeding outcomes among patients receiving coronary stent implantation. Hence, the present study performed a meta-analysis to systematically evaluate the significance of LPR on adverse cardiovascular events. MEDLINE, EMBASE and CENTRAL databases were searched up to November 2020 for relevant studies including patients with acute coronary syndrome undergoing percutaneous coronary intervention. LPR was the exposed arm while the non-LPR group represented the control. The primary outcome of interest was bleeding risk including major and minor bleeding events. Secondary outcomes included all-cause mortality, repeated revascularization, nonfatal myocardial infarction, and stent thrombosis. Study-level outcomes were evaluated in random-effect models. A total of 20 studies with 19,064 patients were included. Pooled analysis showed that LPR was associated with an increased bleeding risk (relative risk [RR] 2.80, 95% confidence interval [CI] 1.95-4.02, p < 0.01). Patients with LPR had a lower risk of non-fatal myocardial infarction (RR 0.59, 95% CI 0.38-0.91, p < 0.05) and of serious vascular events (RR 0.50, 95% CI 0.30-0.84, p < 0.01). Low platelet reactivity is associated with an increased bleeding risk of patients who underwent coronary stent implantation. The results suggest possible benefits of this marker in risk stratification, with potential improvement in risk prediction. There are potential advantages using combinations with other factors in prediction models, however, they require further study. PROSPERO registration number: CRD42019136393).
Sections du résumé
BACKGROUND
Clinical evidence has been controversial regarding the influence of low platelet reactivity (LPR), ischemic and bleeding outcomes among patients receiving coronary stent implantation. Hence, the present study performed a meta-analysis to systematically evaluate the significance of LPR on adverse cardiovascular events.
METHODS
MEDLINE, EMBASE and CENTRAL databases were searched up to November 2020 for relevant studies including patients with acute coronary syndrome undergoing percutaneous coronary intervention. LPR was the exposed arm while the non-LPR group represented the control. The primary outcome of interest was bleeding risk including major and minor bleeding events. Secondary outcomes included all-cause mortality, repeated revascularization, nonfatal myocardial infarction, and stent thrombosis. Study-level outcomes were evaluated in random-effect models.
RESULTS
A total of 20 studies with 19,064 patients were included. Pooled analysis showed that LPR was associated with an increased bleeding risk (relative risk [RR] 2.80, 95% confidence interval [CI] 1.95-4.02, p < 0.01). Patients with LPR had a lower risk of non-fatal myocardial infarction (RR 0.59, 95% CI 0.38-0.91, p < 0.05) and of serious vascular events (RR 0.50, 95% CI 0.30-0.84, p < 0.01).
CONCLUSIONS
Low platelet reactivity is associated with an increased bleeding risk of patients who underwent coronary stent implantation. The results suggest possible benefits of this marker in risk stratification, with potential improvement in risk prediction. There are potential advantages using combinations with other factors in prediction models, however, they require further study. PROSPERO registration number: CRD42019136393).
Identifiants
pubmed: 34355778
pii: VM/OJS/J/75505
doi: 10.5603/CJ.a2021.0084
pmc: PMC10287083
doi:
Substances chimiques
Clopidogrel
A74586SNO7
Platelet Aggregation Inhibitors
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
391-400Références
Ann Intern Med. 2019 Jan 1;170(1):51-58
pubmed: 30596875
Platelets. 2019;30(8):1030-1035
pubmed: 30601072
N Engl J Med. 2009 Sep 10;361(11):1045-57
pubmed: 19717846
J Cardiovasc Pharmacol. 2019 Jan;73(1):56-59
pubmed: 30383607
Platelets. 2011;22(7):521-9
pubmed: 21443410
J Thromb Haemost. 2010 Feb;8(2):250-6
pubmed: 19943882
Eur Heart J. 2013 Oct;34(38):2949-3003
pubmed: 23996286
JACC Cardiovasc Interv. 2013 Aug;6(8):854-63
pubmed: 23968703
PLoS One. 2015 Mar 23;10(3):e0121620
pubmed: 25799149
Circulation. 2011 Jun 14;123(23):2736-47
pubmed: 21670242
J Am Coll Cardiol. 2008 Sep 30;52(14):1128-33
pubmed: 18804738
Circ J. 2010 Apr;74(4):679-85
pubmed: 20173303
Thromb Res. 2015 Aug;136(2):335-40
pubmed: 26033398
Am J Cardiol. 2014 Apr 1;113(7):1124-9
pubmed: 24507863
J Am Heart Assoc. 2020 May 18;9(10):e015439
pubmed: 32394794
Arch Med Sci. 2014 May 12;10(2):203-12
pubmed: 24904651
EuroIntervention. 2009 Aug;5(3):325-9
pubmed: 19736156
JACC Cardiovasc Interv. 2012 Mar;5(3):281-9
pubmed: 22440493
N Engl J Med. 2019 Oct 24;381(17):1621-1631
pubmed: 31479209
J Thromb Haemost. 2012 Oct;10(10):1999-2005
pubmed: 22863374
J Thromb Thrombolysis. 2018 May;45(4):496-503
pubmed: 29450765
J Am Coll Cardiol. 2007 Jun 19;49(24):2312-7
pubmed: 17572245
Am J Cardiol. 2003 Apr 1;91(7):876-8
pubmed: 12667577
J Am Coll Cardiol. 2013 Jun 18;61(24):2428-2434
pubmed: 23602777
Ann Intern Med. 2015 Jun 2;162(11):777-84
pubmed: 26030634
Int J Cardiol. 2013 Sep 20;168(1):523-8
pubmed: 23084816
Circulation. 2004 Jun 29;109(25):3171-5
pubmed: 15184279
Circ J. 2018 Aug 24;82(9):2326-2331
pubmed: 29962391
N Engl J Med. 2007 Nov 15;357(20):2001-15
pubmed: 17982182
Eur Heart J. 2015 Jul 14;36(27):1762-71
pubmed: 25896078
J Am Heart Assoc. 2016 Nov 4;5(11):
pubmed: 27815268
JACC Cardiovasc Interv. 2017 Dec 26;10(24):2560-2570
pubmed: 29268886
Heart Lung Circ. 2017 Jan;26(1):49-57
pubmed: 27451349
Eur Heart J. 2019 Jun 21;40(24):1942-1951
pubmed: 31226213
Lancet. 2017 Oct 14;390(10104):1747-1757
pubmed: 28855078
Eur Heart J. 2006 Oct;27(20):2420-5
pubmed: 17005534
J Thromb Thrombolysis. 2016 Oct;42(3):360-8
pubmed: 27113341
Am J Cardiol. 2011 Apr 1;107(7):995-1000
pubmed: 21256470
Anatol J Cardiol. 2016 Dec;16(12):967-973
pubmed: 27271476
J Thromb Thrombolysis. 2020 Oct;50(3):619-627
pubmed: 32152791