A Systematic Review and Meta-Analysis on the Impact of High On-Treatment Platelet Reactivity on Clinical Outcomes for Patients Taking ADP Receptor Inhibitors Following Lower Limb Arterial Endovascular Intervention

Peter Zlatanovic, Kitty Wong, Stavros K Kakkos, Chris P Twine*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
29 Downloads (Pure)

Abstract

Objective
Adenosine diphosphate (ADP) receptor inhibitors such as clopidogrel are known to be less effective at reducing platelet function for some patients because of a phenomenon called high on-treatment platelet reactivity (HTPR). However, the clinical effect of this for patients undergoing endovascular intervention for peripheral arterial disease is unclear. The aim of this study was to assess the impact of ADP receptor inhibitor HTPR on clinical outcomes following lower limb arterial endovascular intervention for peripheral arterial disease.

Methods
A systematic review and meta-analysis was performed. Primary outcomes included all cause mortality and major bleeding. Secondary outcomes were major adverse cardiovascular events, major adverse limb events, restenosis, and target lesion revascularisation. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results
There were 10 eligible studies including 1 444 patients included in the meta-analysis. The most commonly tested ADP receptor inhibitor was clopidogrel (seven studies). The pooled rate of ADP receptor inhibitor HTPR was 29% (95% CI 27 – 32). The meta-analysis showed that ADP receptor inhibitor HTPR was associated with a greater risk of major adverse limb events (OR 6.25, 95% CI 2.09 – 18.68, p = .001) and a trend towards a higher all cause mortality (OR 1.71, 95% CI 0.99 – 2.94, p = .050) and more major adverse cardiovascular events (OR 4.23, 95% CI 0.46 – 38.92, p = .20) after endovascular intervention. Overall strength of evidence was very low for all outcomes.

Conclusion
ADP receptor inhibitor HTPR was associated with worse clinical outcomes after lower limb endovascular intervention for peripheral arterial disease. Prospective studies are required to determine the impact of modifying the antithrombotic regimen on clinical outcomes.
Original languageEnglish
Pages (from-to)91-101
Number of pages11
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume63
Issue number1
Early online date26 Nov 2021
DOIs
Publication statusPublished - 20 Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 European Society for Vascular Surgery

Keywords

  • ADP receptor inhibitors
  • Endovascular intervention
  • Peripheral arterial disease
  • Platelet function test
  • Platelet reactivity

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