This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND: Platelet function testing has been proposed to better adjust individualized antiplatelet treatment for patients undergoing endovascular treatment for intracranial aneurysms. Its clinical significance needs to be comprehensively evaluated.
PURPOSE: Our aim was to evaluate the impact of platelet function testing–guided versus standard antiplatelet treatment in patients receiving endovascular treatment for intracranial aneurysms.
DATA SOURCES: PubMed, EMBASE, and the Cochrane Library of clinical trials were searched from inception until March 2023.
STUDY SELECTION: Eleven studies comprising 6199 patients were included.
DATA ANALYSIS: ORs with 95% CIs were calculated using random effects models.
DATA SYNTHESIS: The platelet function testing–guided group was associated with a decreased rate of symptomatic thromboembolic events (OR = 0.57; 95% CI, 0.42–0.76; I2 = 26%). No significant difference was found in asymptomatic thromboembolic events (OR = 1.07; 95% CI, 0.39–2.94; I2 = 48%), hemorrhagic events (OR = 0.71; 95% CI, 0.42–1.19; I2 = 34%), intracranial hemorrhagic events (OR = 0.61; 95% CI, 0.03–10.79; I2 = 62%), morbidity (OR = 0.53; 95% CI, 0.05–5.72; I2 = 86%), and mortality (OR = 1.96; 95% CI, 0.64–5.97; I2 = 0%) between the 2 groups. Subgroup analysis suggested that platelet function testing–guided therapy may contribute to fewer symptomatic thromboembolic events in patients who received stent-assisted coiling (OR = 0.43; 95% CI, 0.18–1.02; I2 = 43%) or a combination of stent-assisted and flow-diverter stent placement (OR = 0.61; 95% CI, 0.36–1.02; I2 = 0%) or who changed from clopidogrel to other thienopyridines (OR = 0.64; 95% CI, 0.40–1.02; I2 = 18%), though the difference did not reach statistical significance.
LIMITATIONS: Heterogeneous endovascular treatment methods and adjusted antiplatelet regimens were limitations.
CONCLUSIONS: Platelet function testing–guided antiplatelet strategy significantly reduced the incidence of symptomatic thromboembolic events without any increase in the hemorrhagic events for patients undergoing endovascular treatment for intracranial aneurysms.
ABBREVIATIONS:
- EVT
- endovascular treatment
- HPR
- high on-treatment platelet reactivity
- IA
- intracranial aneurysm
- LTA
- light transmission aggregometry
- PFT
- platelet function testing
- RCT
- randomized controlled trial
- © 2023 by American Journal of Neuroradiology