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Numerous number of evidences show that high on-treatment platelet reactivity (HTPR) is a well-known risk factor for adverse events in patients after PCI. Controversial situations still exist regarding the effectiveness of tailoring antiplatelet therapy according to platelet function monitoring.
The PubMed, Embase, and Cochrane Central databases were searched for randomized trials comparing platelet reactivity adjusted antiplatelet therapy with conventional antiplatelet therapy in patients who underwent PCI. The primary end point was all-cause mortality, major adverse cardiac events (MACE) including cardiovascular death, nonfatal MI, definite/probable stent thrombosis (ST), revascularization, and stroke or transient ischemic attack(TIA). The safety end point was defined as major bleeding event. We derived pooled risk ratios (RRs) with fixed-effects models.
Six studies enrolling 6347 patients were included. Compared with conventional treatment, tailoring antiplatelet fails to reduce all-cause mortality (RR: 0.89, 95% CI: 0.63-1.24, P=0.48), MACE (RR: 1.02, 95% CI:0.92-1.14, P=0.69),myocardial infarction(RR: 1.07, 95%CI: 0.95-1.21, P=0.24), cardiac death (RR: 0.69, 95% CI:0.40-1.19, P=0.09), ST(RR: 0.83, 95% CI: 0.50-1.38, P=0.23), stroke or TIA (RR: 1.08, 95% CI:0.55-2.12, P=0.83),revascularization (RR: 0.96, 95%CI:0.69-1.33,P=0.79) and major bleeding events (RR: 0.79, 95% CI: 0.53-1.17, P=0.24).
compared with medical treatment, tailoring antiplatelet therapy according to platelet reactivity testing fails to reduce all-cause mortality, MACE, and major bleeding events in patients with stenting implantation.