혈소판 약물 반응검사를 토대로 한 항혈소판제 치료방침의 효과성 평가: 체계적 문헌고찰
Effectiveness of Platelet Drug Response Assay for P2Y12 Inhibitor: A Systematic Review of Randomised Controlled Trials
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Objectives: This study aims to compare the effectiveness of individualized antiplatelet therapy guided by platelet drug response assay (PDRA, VerifyNow) in patients with antiplatelet therapy. Methods: Systematic searches on OVID-MEDLINE, Embase, Cochrane Library and 5 Korean databases were performed. Randomized controlled trials (RCTs) was included and a pooled metaanalysis were conducted. The outcomes of interest were ischemic events and bleeding. Results: A total of four RCTs comprising 3,697 patients with coronary artery disease undergoing percutaneous coronary intervention were included in the analysis. Overall risk of bias were ‘low’ but the risk of the allocation concealment were ‘unclear’ in three studies. Compared to the standard antiplatelet therapy, the individualized antiplatelet therapy by PDRA did not decrease the overall mortality (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.48–2.04, I2=66%). It was not available to conduct meta-analysis on cardiovascular mortality, myocardial infarction, and strokes, but there were no significance between the intervention and comparator groups in each study. Also, there was no significant difference in bleeding regardless of the severity (RR 0.85, 95% CI 0.69–1.05, I2=28%). Conclusion: This study demonstrated that the individualzed antiplatelet therapy guided by PDRA did not improve the outcomes including ischemic events or bleeding compared to the standard therapy. Due to the heterogeneity and divergence among the studies, further RCTs are still needed examining the results. Keywords Platelet
Abstract
Objectives: This study aims to compare the effectiveness of individualized antiplatelet therapy guided by platelet drug response assay (PDRA, VerifyNow) in patients with antiplatelet therapy. Methods: Systematic searches on OVID-MEDLINE, Embase, Cochrane Library and 5 Korean databases were performed. Randomized controlled trials (RCTs) was included and a pooled metaanalysis were conducted. The outcomes of interest were ischemic events and bleeding. Results: A total of four RCTs comprising 3,697 patients with coronary artery disease undergoing percutaneous coronary intervention were included in the analysis. Overall risk of bias were ‘low’ but the risk of the allocation concealment were ‘unclear’ in three studies. Compared to the standard antiplatelet therapy, the individualized antiplatelet therapy by PDRA did not decrease the overall mortality (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.48–2.04, I2=66%). It was not available to conduct meta-analysis on cardiovascular mortality, myocardial infarction, and strokes, but there were no significance between the intervention and comparator groups in each study. Also, there was no significant difference in bleeding regardless of the severity (RR 0.85, 95% CI 0.69–1.05, I2=28%). Conclusion: This study demonstrated that the individualzed antiplatelet therapy guided by PDRA did not improve the outcomes including ischemic events or bleeding compared to the standard therapy. Due to the heterogeneity and divergence among the studies, further RCTs are still needed examining the results. Keywords Platelet
참고문헌 (23)
- Korean Society of Hematology, "Hematology" (2018), Panmun Education
- 정영훈, "관상동맥질환에서 항혈소판제 치료: 과유불급?", 대한내과학회 추계학술발표논문집, pp.78~81 (2015)
- Zhou K, "High on-treatment platelet reactivity is associated with poor outcomes after ischemic stroke : a meta-analysis", Acta Neurol Scand, 146, pp.205~224 (2022)
- Wisman PP, "Platelet-reactivity tests identify patients at risk of secondary cardiovascular events : a systematic review and meta-analysis", J Thromb Haemost, 12, pp.736~747 (2014)
- Yamaguchi Y, "Effects of VerifyNow P2Y12 test and CYP2C19*2 testing on clinical outcomes of patients with cardiovascular disease : a systematic review and meta-analysis", Platelets, 24, pp.352~361 (2013)
- Sibbing D, "Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention", JACC Cardiovasc Interv, 12, pp.1521~1537 (2019)
- Collet JP, "2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation", Rev Esp Cardiol(Engl Ed), 74, pp.544~ (2021)
- Higgins JP, "The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials", BMJ, 343, pp.d5928~ (2011)
- Higgins JP, "The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials", BMJ, 18(343), pp.d5928~ (2011)
- 김수영, "체계적 문헌고찰 및 임상진료지침 매뉴얼 개발" (2011), 한국보건의료연구원
- Jeong YH, "Pharmacodynamic profile and prevalence of bleeding episode in East Asian patients with acute coronary syndromes treated with prasugrel standard-dose versus de-escalation strategy : a randomized A-MATCH trial", Thromb Haemost, 121, pp.1376~1386 (2021)
- Collet JP, "Bedside monitoring to adjust antiplatelet therapy for coronary stenting", N Engl J Med, 367, pp.2100~2109 (2012)
- Cayla G, "Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome(ANTARCTIC) : an open-label, blinded-endpoint, randomised controlled superiority trial", Lancet, 388, pp.2015~2022 (2016)
- Tomaniak M, "Can prasugrel decrease the extent of periprocedural myocardial injury during elective percutaneous coronary intervention", Pol Arch Intern Med, 127, pp.730~740 (2017)
- Peng W, "Clinical outcomes of individualized antiplatelet therapy based on platelet function test in patients after percutaneous coronary intervention : a systematic review and metaanalysis", J Cardiovasc Pharmacol, 81, pp.270~279 (2023)
- Price MJ, "Standard-vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention : the GRAVITAS randomized trial", JAMA, 305, pp.1097~1105 (2011)
- Ari H, "The EFFect of hIgh-dose ClopIdogrel treatmENT in patients with clopidogrel resistance(the EFFICIENT trial)", Int J Cardiol, 157, pp.374~380 (2012)
- Trenk D, "A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents : results of the TRIGGER-PCI(testing platelet reactivity in patients undergoing elective stent placement on clopidogrel to guide alternative therapy with prasugrel)study", J Am Coll Cardiol, 59, pp.2159~2164 (2012)
- Tousek P, "Clopidogrel up-titration versus standard dose in patients with high residual platelet reactivity after percutaneous coronary intervention : a single-center pilot randomised study", Int J Cardiol, 150, pp.231~232 (2011)
- Mshelbwala FS, "Impact of routine platelet reactivity testing with VerifyNow assay on antiplatelet choice after percutaneous coronary intervention", Clin Pharmacol, 12, pp.35~41 (2020)
- Bagai A, "Association of measured platelet reactivity with changes in P2Y12 receptor inhibitor therapy and outcomes after myocardial infarction : insights into routine clinical practice from the TReatment with ADP receptor iNhibitorS : Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome(TRANSLATE-ACS)study", Am Heart J, 187, pp.19~28 (2017)
- Wong P, "Accumetrics-based clopidogrel dosing in endovascular neurosurgery", Neurol Res, 37, pp.998~1005 (2015)
- Neyens R, "Platelet function testing with a VerifyNow-directed personalized antiplatelet strategy and associated rates of thromboembolic complications after pipeline embolization for complex cerebral aneurysms", World Neurosurg, 138, pp.e674~e682 (2020)