Takeaway
- Use of platelet function testing during dual antiplatelet therapy, including a P2Y12 antagonist, in acute coronary syndromes does not improve clinical outcomes.
Why This Matters
- Findings do not support the routine inclusion of platelet function testing into clinical guidelines for the management of acute coronary syndromes.
Study Design
- Researchers at King's College London conducted a meta-analysis of 5 randomised controlled trials including 7691 patients with acute coronary syndromes.
- Funding: A King’s British Heart Foundation Centre of Excellence Award.
Key Results
- Platelet function testing-guided dual antiplatelet therapy did not show any significant reduction in (risk ratio [RR]; 95% CI):
- major adverse cardiovascular (CV) events (0.95; 0.83 to 1.08; I2, 63%; P=0.42); and
- individual cardiac events:
- CV death (0.76; 0.47 to 1.23; P=0.26);
- myocardial infarction (0.96; 0.76 to 1.22; P=0.74);
- stent thrombosis (0.92; 0.41 to 2.07; P=0.83);
- stroke (0.91; 0.57 to 1.48; P=0.72);
- target vessel revascularisation (1.06; 0.90 to 1.25; P=0.47); and
- overall clinical benefit (0.90; 0.76 to 1.06; P=0.22).
- No significant difference was observed between platelet function testing-guided and standard dual antiplatelet therapy in the risks of (RR; 95% CI):
- major bleeding (0.98; 0.78 to 1.22; P=0.84);
- minor bleeding (0.89; 0.74 to 1.06; P=0.19); and
- any bleeding (1.04; 0.96 to 1.12; P=0.33).
Limitations
- Heterogeneity among studies.
- All randomised controlled trials were high-risk studies.
References
References
