Vascular risk levels affect the predictive value of platelet reactivity for the occurrence of MACE in patients on clopidogrel
Key result
High on-clopidogrel platelet reactivity was associated with an increased risk of MACE in patients with ≥2 risk factors (HR 3.7, p=0.0003), with the risk magnitude dependent on baseline risk levels.
Why the study?
Does the predictive value of on-clopidogrel platelet reactivity for MACE depend on the patient's baseline cardiovascular risk level?
Population
6,478 clopidogrel-treated patients from 13 prospective studies
Comparison
High or medium on-clopidogrel platelet… vs Low on-clopidogrel platelet reactivity
Design
Meta-analysis
Follow-up
median 12 months
Authors
Discussion
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Implication
May support targeted platelet reactivity testing in higher-risk patients; extends evidence for risk-stratified approaches in future trials.
Study Design
Type
Meta-Analysis (n=6,478)
Structured PICO
Does the predictive value of on-clopidogrel platelet reactivity for MACE depend on the patient's baseline cardiovascular risk level?
P
Population
6,478 clopidogrel-treated patients from 13 prospective studies followed for a median of 12 months.
E
Exposure
High or medium on-clopidogrel platelet reactivity (PR) measured by ADP-induced light transmission aggregometry
C
Comparator
Low on-clopidogrel platelet reactivity
O
Outcome
Major adverse cardiovascular events (MACE), defined as acute coronary syndromes (ACS), ischaemic strokes, and vascular deathscomposite
Main Result
Hazard Ratio: 3.7
p-value: p=0.0003
The predictive value of on-clopidogrel platelet reactivity for MACE is strongly dependent on the patient's baseline cardiovascular risk level, suggesting PR testing may be most useful in higher-risk patients.
Cite This Study
Fontana et al. (2015) conducted a meta-analysis in Patients on clopidogrel (n=6,478). High on-clopidogrel platelet reactivity vs. Low/normal platelet reactivity was evaluated on MACE (acute coronary syndromes, ischaemic strokes, and vascular deaths) (HR 3.7, p=0.0003). High on-clopidogrel platelet reactivity was associated with an increased risk of MACE in patients with ≥2 risk factors (HR 3.7, p=0.0003), with the risk magnitude dependent on baseline risk levels.