Guided Anti-P2Y12 Therapy in Patients Undergoing PCI: Three Systematic Reviews with Meta-analyses of Randomized Controlled Trials with Homogeneous Design

The value of guided therapy (GT) with anti-P2Y12 drugs in percutaneous coronary intervention (PCI) is unclear. Meta-analyses lumped together randomized controlled trials (RCTs) with heterogeneous designs, comparing either genotype-GT or platelet function test (PFT)-GT with unguided therapy. Some met...

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Vydáno v:	Thrombosis and haemostasis Ročník 124; číslo 5; s. 482
Hlavní autoři:	Birocchi, Simone, Rocchetti, Matteo, Minardi, Alessandro, Podda, Gian Marco, Squizzato, Alessandro, Cattaneo, Marco
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Germany 01.05.2024
Témata:	Blood Platelets - drug effects Coronary Artery Disease - therapy Genotype Hemorrhage - chemically induced Humans Percutaneous Coronary Intervention - adverse effects Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Platelet Function Tests Purinergic P2Y Receptor Antagonists - adverse effects Purinergic P2Y Receptor Antagonists - therapeutic use Randomized Controlled Trials as Topic Receptors, Purinergic P2Y12 Treatment Outcome
ISSN:	2567-689X, 2567-689X
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Shrnutí:	The value of guided therapy (GT) with anti-P2Y12 drugs in percutaneous coronary intervention (PCI) is unclear. Meta-analyses lumped together randomized controlled trials (RCTs) with heterogeneous designs, comparing either genotype-GT or platelet function test (PFT)-GT with unguided therapy. Some meta-analysis also included RCTs that did not explore GT, but included the effects of switching patients with high on-treatment platelet reactivity (HTPR) to alternative therapies (HTPR-Therapy). We performed three distinct systematic reviews/meta-analyses, each exploring only RCTs with homogeneous design. MEDLINE, Embase, and Central databases were searched for RCTs testing genotype-GT, PFT-GT, or HTPR-Therapy in PCI-treated patients, through October 1, 2022. Two reviewers extracted the data. Risk ratios (RRs) (95% confidence intervals) were calculated. Primary outcomes were major bleedings (MBs) and major adverse cardiovascular events (MACE). In seven genotype-GT RCTs, RRs were: MB, 1.06 (0.73-1.54; = 0.76); MACE, 0.65 (0.47-0.91; = 0.01), but significant risk reduction was observed in RCTs performed in China (0.30, 0.16-0.54; < 0.0001) and not elsewhere (0.75, 0.48-1.18; = 0.21). In six PFT-GT RCTs, RRs were: MB, 0.91 (0.64-1.28, = 0.58); MACE, 0.82 (0.56-1.19; = 0.30): 0.62 (0.42-0.93; = 0.02) in China, 1.08 (0.82-1.41; = 0.53) elsewhere. In eight HTPR-Therapy RCTs, RRs were: MB, 0.71 (0.41-1.23; = 0.22); MACE, 0.57 (0.44-0.75; < 0.0001): 0.56 (0.43-0.74, < 0.0001) in China, 0.58 (0.27-1.23, = 0.16) elsewhere. No GT strategy affected MB. Overall, genotype-GT but not PFT-GT reduced MACE. However, genotype-GT and PFT-GT reduced MACE in China, but not elsewhere. PFT-GT performed poorly compared to HTPR-Therapy, likely due to inaccurate identification of HTPR patients by PFT.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	2567-689X 2567-689X
DOI:	10.1055/a-2149-4344