UNIGE document Scientific Article
previous document  unige:82468  next document
add to browser collection
Title

Vascular risk levels affect the predictive value of platelet reactivity for the occurrence of MACE in patients on clopidogrel. Systematic review and meta-analysis of individual patient data

Authors
Hochholzer, Willibald
Neumann, Franz Josef
Ten Berg, Jurriën
Janssen, Paul W.
Geisler, Tobias
Gawaz, Meinrad
show hidden authors show all authors [1 - 20]
Published in Thrombosis and Haemostasis. 2016, vol. 115, no. 4, p. 844-55
Abstract Prior studies have shown an association between high on-clopidogrel platelet reactivity (PR) and the risk of major adverse cardiovascular events (MACE). However, large intervention trials on PR-tailored treatments have been neutral. The role and usefulness of PR with regard to levels of cardiovascular risk are unclear. We undertook a systematic review and meta-analysis of individual patient data on MACE outcomes (acute coronary syndromes (ACS), ischaemic strokes, and vascular deaths) in relation to PR and its interaction with cardiovascular risk levels. PR was determined using ADP-induced light transmission aggregometry with a primary concentration of 20 µM ADP. Thirteen prospective studies totaled 6,478 clopidogrel-treated patients who experienced 421 MACE (6.5 %) during a median follow-up of 12 months. The strength of the association between the risk of MACE and PR increased significantly (p=0.04) with the number of risk factors present (age> 75 years, ACS at inclusion, diabetes, and hypertension). No association was detected in patients with no risk factor (p=0.48). In patients presenting one risk factor, only high-PR was associated with an increased risk of MACE (HR 3.2, p=0.001). In patients presenting ≥ 2 risk factors, the increase of risk started from medium-PR (medium-PR: HR=2.9, p=0.0004; high-PR: HR=3.7, p=0.0003). PR allowed the reclassification of 44 % of the total population to a different risk level for the outcome of MACE, mostly in intermediate or high risk patients. In conclusion, the magnitude of the association between PR and MACE risk is strongly dependent on the level of cardiovascular risk faced by patients on clopidogrel.
Identifiers
PMID: 26607655
Full text
Article (Published version) (252 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Structures
Research groups Geneva Platelet Group (13)
Epidémiologie clinique (115)
Citation
(ISO format)
RENY, Jean-Luc et al. Vascular risk levels affect the predictive value of platelet reactivity for the occurrence of MACE in patients on clopidogrel. Systematic review and meta-analysis of individual patient data. In: Thrombosis and Haemostasis, 2016, vol. 115, n° 4, p. 844-55. https://archive-ouverte.unige.ch/unige:82468

131 hits

2 downloads

Update

Deposited on : 2016-04-08

Export document
Format :
Citation style :