Guided antiplatelet therapy improves outcomes for PCI patients

Antiplatelet therapy guided by platelet function or genetic testing is associated with better outcomes for patients undergoing percutaneous coronary intervention (PCI), according to a new meta-analysis in the Lancet.

“Early randomized controlled trials did not find any benefit with a guided approach,” wrote lead author Mattia Galli, MD, of Catholic University of the Sacred Heart in Rome, and colleagues. “Pitfalls in trial designs, such as the inclusion of low-risk patients, inadequate identification of patients with impaired clopidogrel-induced platelet inhibition, and infrequent use of potent P2Y12 inhibitors, could have contributed to these findings. These considerations, as well as the broader availability of rapid bedside assays and more potent P2Y12 inhibitors, have led to the design of investigations better suited to define the potential benefits of a guided selection of antiplatelet therapy.”

The study’s authors reviewed data from 11 randomized controlled trials and three observational studies covering more than 20,000 patients. Follow-up data for at least six months was available for all 14 studies.

Overall, the team found, taking a guided approach was associated with a reduction in major adverse cardiovascular events. There was a consistent drop in the risk of cardiovascular mortality, myocardial infarction, stent thrombosis and stroke.

When looking at all-cause mortality, however, no difference was observed between the two treatment options.

Guided antiplatelet therapy was also associated with a reduction in minor bleeding, the team added. There was not a reduction in major bleeding events, however.

“These observations provide support for the use of platelet function testing or genetic testing as tools to guide the selection of antiplatelet therapy in patients undergoing PCI,” the authors wrote.

Click here to read the full analysis.