High on-treatment platelet reactivity in peripheral arterial disease: A systematic review.

Autor:	Goncalves LN; Haaglanden Medisch Centrum, The Hague, the Netherlands., van Velze V; Haaglanden Medisch Centrum, The Hague, the Netherlands., Klok FA; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Gal P; Centre for Human Drug Research, Leiden, the Netherlands., Vos RC; Department of Public Health and Primary Care, Leiden University Medical Center Campus the Hague, The Hague, the Netherlands.; Health Campus The Hague, The Hague, the Netherlands., Hamming JF; Department of Surgery, Leiden University Medical Center, University Vascular Center Leiden, Leiden, The Hague, the Netherlands., van der Bogt KEA; Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands.; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.; University Vascular Center Leiden, The Hague, the Netherlands.
Jazyk:	angličtina
Zdroj:	Vascular [Vascular] 2024 Dec; Vol. 32 (6), pp. 1177-1190. Date of Electronic Publication: 2023 Nov 11.
DOI:	10.1177/17085381231214324
Abstrakt:	Objectives: To highlight current evidence pertaining to the measurement methods and prevalence of high on-treatment platelet reactivity (HTPR) in patients with PAD, as well as to evaluate the relationship between HTPR and recurrent adverse cardiovascular and limb events in PAD patients. Methods: A systematic review of English-language literature on HTPR in patients with PAD. An electronic literature search of PubMed and Medline was performed in May 2021. Results: A total of 29 studies with a total number of 11,201 patients with PAD were identified. HTPR during clopidogrel treatment ranges from 9.8 to 77%, and during aspirin treatment ranges from 4.1 to 50% of PAD patients. HTPR was associated with adverse clinical outcomes. The need for limb revascularisation was higher in patients with HTPR during clopidogrel use. Similarly, HTPR during aspirin use in the PAD population was predictive of adverse cardiovascular events (HR 3.73; 95% CI, 1.43-9.81; p = .007). A wide range of techniques were applied to measure platelet resistance, without consensus on cut-off values. Furthermore, differing patient populations, a variety of antiplatelet regimens, and differing clinical endpoints highlight the high degree of heterogeneity in the studies included in this review. Conclusion: No consensus on technique or cut-off values for HTPR testing has been reached. Patients with HTPR are potentially at a greater risk of adverse limb-related and cardiovascular events than patients sensitive to antiplatelet therapy illustrating the need for clinical implementation of HTPR testing. Future research must aim for consistent methodology. Adaptation of antiplatelet therapy based on HTPR results requires further exploration. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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