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Intensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response: A Meta-analysis of Randomized Controlled Trials

Background:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clin... Full description

Journal Title: Chinese Medical Journal 2016, Vol.129 (8), p.984-991
Main Author: Xu, Lei
Other Authors: Hu, Xiao-Wei , Zhang, Shu-Hua , Li, Ji-Min , Zhu, Hui , Xu, Ke , Chen, Jun , Li, Chun-Jian
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: China: Wolters Kluwer - Medknow Publications
ID: ISSN: 0366-6999
Link: https://www.ncbi.nlm.nih.gov/pubmed/27064045
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title: Intensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response: A Meta-analysis of Randomized Controlled Trials
format: Article
creator:
  • Xu, Lei
  • Hu, Xiao-Wei
  • Zhang, Shu-Hua
  • Li, Ji-Min
  • Zhu, Hui
  • Xu, Ke
  • Chen, Jun
  • Li, Chun-Jian
subjects:
  • Aggregation
  • Analysis
  • Blood platelets
  • Cardiac patients
  • Cardiology
  • Cardiovascular disease
  • Cardiovascular Diseases - mortality
  • Care and treatment
  • Clinical outcomes
  • Clinical trials
  • Coronary Artery Disease
  • Coronary Artery Disease
  • Individualized Medicine
  • Platelet Aggregation Inhibitor
  • Platelet Function Test
  • Coronary vessels
  • Dosage and administration
  • Health aspects
  • Hospitals
  • Humans
  • Individualized Medicine
  • Medicine
  • Meta Analysis
  • Myocardial Infarction - prevention & control
  • Percutaneous Coronary Intervention - adverse effects
  • Platelet Aggregation Inhibitor
  • Platelet Aggregation Inhibitors - therapeutic use
  • Platelet Function Test
  • Quality
  • Randomized Controlled Trials as Topic
  • Stents
  • Stents - adverse effects
  • Studies
  • Thrombosis
  • Ticlopidine - analogs & derivatives
  • Ticlopidine - therapeutic use
  • Transluminal angioplasty
  • 氯吡格雷
  • 血小板
  • 随机对照试验
ispartof: Chinese Medical Journal, 2016, Vol.129 (8), p.984-991
description: Background:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods:Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results:Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular (CV) death,nonfatal myocardial infarction (MI),and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm (relative risk [RR] =0.45,95% confidence interval [CI]:0.36-0.57,P 〈 0.000,01),whereas bleeding was similar between the two arms (RR =1.05,95% CI:0.86-1.27,P =0.65).Conclusions:IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis (ST) without an increased risk of bleeding in patients undergoing PCI and with CLR.
language: eng
source:
identifier: ISSN: 0366-6999
fulltext: no_fulltext
issn:
  • 0366-6999
  • 2542-5641
url: Link


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titleIntensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response: A Meta-analysis of Randomized Controlled Trials
creatorXu, Lei ; Hu, Xiao-Wei ; Zhang, Shu-Hua ; Li, Ji-Min ; Zhu, Hui ; Xu, Ke ; Chen, Jun ; Li, Chun-Jian
creatorcontribXu, Lei ; Hu, Xiao-Wei ; Zhang, Shu-Hua ; Li, Ji-Min ; Zhu, Hui ; Xu, Ke ; Chen, Jun ; Li, Chun-Jian
descriptionBackground:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods:Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results:Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular (CV) death,nonfatal myocardial infarction (MI),and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm (relative risk [RR] =0.45,95% confidence interval [CI]:0.36-0.57,P 〈 0.000,01),whereas bleeding was similar between the two arms (RR =1.05,95% CI:0.86-1.27,P =0.65).Conclusions:IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis (ST) without an increased risk of bleeding in patients undergoing PCI and with CLR.
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subjectAggregation ; Analysis ; Blood platelets ; Cardiac patients ; Cardiology ; Cardiovascular disease ; Cardiovascular Diseases - mortality ; Care and treatment ; Clinical outcomes ; Clinical trials ; Coronary Artery Disease ; Coronary Artery Disease; Individualized Medicine; Platelet Aggregation Inhibitor; Platelet Function Test ; Coronary vessels ; Dosage and administration ; Health aspects ; Hospitals ; Humans ; Individualized Medicine ; Medicine ; Meta Analysis ; Myocardial Infarction - prevention & control ; Percutaneous Coronary Intervention - adverse effects ; Platelet Aggregation Inhibitor ; Platelet Aggregation Inhibitors - therapeutic use ; Platelet Function Test ; Quality ; Randomized Controlled Trials as Topic ; Stents ; Stents - adverse effects ; Studies ; Thrombosis ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Transluminal angioplasty ; 氯吡格雷 ; 血小板 ; 随机对照试验
ispartofChinese Medical Journal, 2016, Vol.129 (8), p.984-991
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2Copyright: © 2016 Chinese Medical Journal 2016
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0Intensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response: A Meta-analysis of Randomized Controlled Trials
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descriptionBackground:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods:Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results:Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular (CV) death,nonfatal myocardial infarction (MI),and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm (relative risk [RR] =0.45,95% confidence interval [CI]:0.36-0.57,P 〈 0.000,01),whereas bleeding was similar between the two arms (RR =1.05,95% CI:0.86-1.27,P =0.65).Conclusions:IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis (ST) without an increased risk of bleeding in patients undergoing PCI and with CLR.
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11Coronary Artery Disease; Individualized Medicine; Platelet Aggregation Inhibitor; Platelet Function Test
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notes
0Background:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods:Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results:Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular (CV) death,nonfatal myocardial infarction (MI),and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm (relative risk [RR] =0.45,95% confidence interval [CI]:0.36-0.57,P 〈 0.000,01),whereas bleeding was similar between the two arms (RR =1.05,95% CI:0.86-1.27,P =0.65).Conclusions:IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis (ST) without an increased risk of bleeding in patients undergoing PCI and with CLR.
111-2154/R
2Coronary Artery Disease; Individualized Medicine; Platelet Aggregation Inhibitor; Platelet Function Test
3Lei Xu and Xiao-Wei Hu contributed equally to this work.
abstractBackground:Clopidogrel low response (CLR) is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI),and intensified antiplatelet treatments (IAT) guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods:Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results:Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular (CV) death,nonfatal myocardial infarction (MI),and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm (relative risk [RR] =0.45,95% confidence interval [CI]:0.36-0.57,P 〈 0.000,01),whereas bleeding was similar between the two arms (RR =1.05,95% CI:0.86-1.27,P =0.65).Conclusions:IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis (ST) without an increased risk of bleeding in patients undergoing PCI and with CLR.
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pubWolters Kluwer - Medknow Publications
pmid27064045
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