Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23508
Title: Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis.
Austin Authors: Lim, Soon Tjin;Thijs, Vincent N ;Murphy, Stephen J X;Fernandez-Cadenas, Israel;Montaner, Joan;Offiah, Chika;Marquardt, Lars;Kelly, Peter J;Bath, Philip M;Lim, Su-Yin;Ford, Gary A;Norrving, Bo;Cox, Dermot;Prodan, Calin I;Barber, Philip A;Werring, David J;Perry, Richard;Zgaga, Lina;Dawson, Jesse;McCabe, Dominick J H
Affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
Stroke Clinical Trials Network Ireland, Dublin, Ireland. Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK
Irish Centre for Vascular Biology, Dublin, Ireland
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland. Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Vascular Neurology Research Foundation, C/O Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Tallaght, Dublin 24, Ireland
Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
Stroke Trials Unit, University of Nottingham, Nottingham, UK
Department of Neurology, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma, USA
Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
Oxford University Hospital NHS Foundation Trust, Oxford, UK
Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK
Department of Neurology, Asklepios Klinik Wandsbek, Hamburg, Germany
Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
Irish Centre for Vascular Biology, Dublin, Ireland
University of Oxford, Oxford, UK
Neurovascular Clinical Science Unit, Mater University Hospital, University College Dublin, Dublin, Ireland
Stroke Clinical Trials Network Ireland, Dublin, Ireland
Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Seville, Spain
Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Faculty of Health and Medical Sciences, Taylor's University School of Medicine, Sungai Buloh, Malaysia
Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
Department of Public Health and Primary Care, Trinity College Dublin, University of Dublin, Dublin, Ireland
Issue Date: 9-Jun-2020
metadata.dc.date: 2020-06-09
Publication information: Journal of neurology 2020; online first: 9 june
Abstract: The prevalence of ex vivo 'high on-treatment platelet reactivity (HTPR)' and its relationship with recurrent vascular events/outcomes in patients with ischaemic cerebrovascular disease (CVD) is unclear. A systematic review and meta-analysis was performed in accordance with the PRISMA statement. MEDLINE, EMBASE and Cochrane Library were searched for completed manuscripts until May 2019 on TIA/ischaemic stroke patients, ≥ 18 years, treated with commonly-prescribed antiplatelet therapy, who had platelet function/reactivity testing and prospective follow-up data on recurrent stroke/TIA, myocardial infarction, vascular death or other cerebrovascular outcomes. Data were pooled using random-effects meta-analysis. Primary outcome was the composite risk of recurrent stroke/TIA, myocardial infarction or vascular death. Secondary outcomes were recurrent stroke/TIA, severe stroke (NIHSS > 16) or disability/impairment (modified Rankin scale ≥ 3) during follow-up. Antiplatelet-HTPR prevalence was 3-65% with aspirin, 8-56% with clopidogrel and 1.8-35% with aspirin-clopidogrel therapy. Twenty studies (4989 patients) were included in our meta-analysis. There was a higher risk of the composite primary outcome (OR 2.93, 95% CI 1.90-4.51) and recurrent ischaemic stroke/TIA (OR 2.43, 95% CI 1.51-3.91) in patients with vs. those without 'antiplatelet-HTPR' on any antiplatelet regimen. These risks were also more than twofold higher in patients with vs. those without 'aspirin-HTPR' and 'dual antiplatelet-HTPR', respectively. Clopidogrel-HTPR status did not significantly predict outcomes, but the number of eligible studies was small. The risk of severe stroke was higher in those with vs. without antiplatelet-HTPR (OR 2.65, 95% CI 1.00-7.01). Antiplatelet-HTPR may predict risks of recurrent vascular events/outcomes in CVD patients. Given the heterogeneity between studies, further prospective, multi-centre studies are warranted.
URI: http://ahro.austin.org.au/austinjspui/handle/1/23508
DOI: 10.1007/s00415-020-09932-y
ORCID: 0000-0003-0493-4516
0000-0002-6614-8417
PubMed URL: 32518978
Type: Journal Article
Subjects: Ischaemic stroke
Meta-analysis
Platelet function/on-treatment platelet reactivity
Systematic review
Transient ischaemic attack
Appears in Collections:Journal articles

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