Tailored antiplatelet therapy and clinical adverse outcomes
- Jiabei Li1,2,
- Zhao Jian3,
- Mingbao Song1,2,
- Wenyun Guo2,
- Guozhu Chen2,
- Wei Lu1,
- Dehui Qian1,
- Jing'e Ouyang4,
- Jie Yu1,2,
- Houyuan Hu5,
- Jun Jin1,
- Xiaojing Wu1,2,
- Lan Huang1,2
- 1Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- 2PLA Institute of Cardiovascular Disease, Chongqing, China
- 3Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- 4Department of Cardiology, Fuzhou General Hospital, Fuzhou, Fujian, China
- 5Department of Cardiology, Southwest Hospital, Chongqing, China
- Correspondence to Dr Jun Jin, Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Street, Chongqing 400037, China;
- Received 14 June 2013
- Revised 4 October 2013
- Accepted 7 October 2013
- Published Online First 5 November 2013
Objective The clinical evidence regarding the influence of tailored antiplatelet strategy on adverse outcomes has been controversial. The aim of the study was to evaluate the significance of tailored antiplatelet therapy with respect to clinical adverse events in antiplatelet-resistant patients.
Methods Randomised studies that assess clinical relevance of personalised antiplatelet treatment in antiplatelet-resistant patients were identified through a literature search: PubMed, EMBASE, Web of Science and the Cochrane Library. The primary endpoint was the composite of death from any cause and stent thrombosis. All total clinical adverse events and bleeding complications were evaluated.
Results Data were combined across seven randomised studies comprising 12 048 subjects, of whom 3738 (31.0%) were found to be antiplatelet-resistant. Antiplatelet-resistant patients provided with tailored antiplatelet therapy showed less risk of death or stent thrombosis than those assigned conventional antiplatelet treatment (0.5% vs 2.2%; OR (95% CI) 0.25 (0.13 to 0.49), p<0.0001). A significant benefit in terms of total adverse event risk reduction was observed during follow-up for tailored vs conventional antiplatelet therapy (5.5% vs 10.0%; OR (95% CI) 0.40 (0.20 to 0.77), p=0.006). No statistical difference in bleeding complications was observed between these two groups (p=0.08).
Conclusions In the study, personalised antiplatelet treatment for antiplatelet resistance was found to be associated with less occurrence of death or stent thrombosis and the less risk of total clinical adverse events than conventional treatment, without increasing the risk of bleeding complications.