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May 1, 2015Health Technology AssessmentOpen Access

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

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Why the study?

Does platelet function testing to designate 'aspirin resistance' predict adverse clinical outcomes in patients on aspirin therapy with established cardiovascular disease, cerebrovascular disease, or diabetes?

Population

Patients aged ≥18 years on aspirin, with established cardiovascular disease, cerebrovascular disease, or…

Comparison

Platelet function tests including light… vs Patients designated as 'aspirin sensitive' by…

Design

Systematic_review

Follow-up

7 days or longer

Authors

JDJanine DretzkeRRRichard D RileyMLMarie Lordkipanidzé

Discussion

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Overview

Does not support routine platelet function testing for aspirin resistance; leaves prognostic value unresolved pending standardized assays.

Structured PICO

Does platelet function testing to designate 'aspirin resistance' predict adverse clinical outcomes in patients on aspirin therapy with established cardiovascular disease, cerebrovascular disease, or diabetes?

P
Population
Patients aged ≥18 years on aspirin, with established cardiovascular disease, cerebrovascular disease, or diabetes (108 relevant studies analyzed, 58 in patients on aspirin monotherapy).
I
Intervention
Platelet function tests (PFTs) including light transmission aggregometry, VerifyNow Aspirin, thromboxane metabolite measurement, PFA-100, whole-blood aggregometry, and thromboelastography to designate 'aspirin resistance'.
C
Comparator
Patients designated as 'aspirin sensitive' by the same platelet function tests.
O
Outcome
Adverse clinical outcomes including vascular events, haemorrhagic events, all-cause mortality, mortality due to vascular events, and composite outcomes (e.g., major adverse cardiac events [MACE]) occurring ≥7 days post-test.composite

Although some platelet function tests may have prognostic value for detecting 'aspirin resistance', methodological heterogeneity prevents quantitative summary and routine clinical use is not currently supported.

Limitations

  • Poor or incomplete reporting of studies suggests a potentially large volume of inaccessible data.
  • Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT.
  • Clinical and methodological heterogeneity across studies precluded meta-analysis.
  • Given the lack of robust data the economic modelling was speculative.

Cite This Study

Dretzke et al. (2015) studied this question.

synapsesocial.com/papers/6a7cca4e93373eeacd191133https://doi.org/10.3310/hta19370
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of gender difference on platelet reactivity2011 · 87 citations
  2. 2The PFA-100® detects sub-optimal antiplatelet responses in patients on aspirin2004 · 28 citations
  3. 3Aspirin Responsiveness in Acute Brain Ischaemia: Association with Stroke Severity and Clinical Outcome2008 · 44 citations
  4. 4Twice daily dosing of aspirin improves platelet inhibition in whole blood in patients with type 2 diabetes mellitus and micro- or macrovascular complications2011 · 117 citations
  5. 5The mechanism of the effect of aspirin on human platelets. I. Acetylation of a particulate fraction protein.1975 · 865 citations