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BioMed Research International
Volume 2014, Article ID 610296, 13 pages
Review Article

The Prognostic Impact of High On-Treatment Platelet Reactivity with Aspirin or ADP Receptor Antagonists: Systematic Review and Meta-Analysis

1Department of Internal Medicine, Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
2Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
3Mid America Heart Institute at Saint Luke’s Hospital, Kansas City, MO, USA
4Politecnico of Turin, Turin, Italy
5New York University School of Medicine, New York, NY, USA

Received 15 February 2014; Revised 26 June 2014; Accepted 26 June 2014; Published 13 October 2014

Academic Editor: Ahmed Abdel-Latif

Copyright © 2014 Fabrizio D’Ascenzo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Negative results of recent randomized clinical trials testing the hypothesis of target therapy for patients with high on-treatment platelet reactivity (HOPR) have questioned its independent impact on clinical outcomes. 26 studies with 28.178 patients were included, with a median age of 66.8 (64–68) and 22.7% (22.4–27.8), of female gender. After a median follow-up of 1 year (0.1–1), cardiac adverse events occurred in 8.3% (3–11; all results are reported as median and interquartile range) of patients. Pooling all studies together, on-treatment platelet reactivity significantly increased the risk of adverse events (OR 1.33 [1.09, 1.64], ). However, a sensitivity analysis showed that HOPR did not increase the risk of adverse events for patients with ACS, AMI, or stable angina as well as patients resistant to aspirin, ADP antagonists, or both. For all studies, publication bias was formally evident; after adjusting for this, HOPR did not significantly increase adverse cardiac events (OR 1.1 : 0.89–1.22, 0%). Conclusions. After adjusting for clinical confounders (like risk factors and clinical presentation) and for relevant publication bias, HOPR was not an independent prognostic indicator in unselected patients with both stable and unstable coronary disease for an adverse cardiac event. The clinical importance of HOPR for high-risk populations remains to be assessed.