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PT  - JOURNAL ARTICLE
AU  - Wang, X.
AU  - Luo, L.
AU  - Wang, Y.
AU  - An, Z.
TI  - Effect of Platelet Function Testing Guidance on Clinical Outcomes for Patients with Intracranial Aneurysms Undergoing Endovascular Treatment
AID  - 10.3174/ajnr.A7923
DP  - 2023 Aug 01
TA  - American Journal of Neuroradiology
PG  - 928--933
VI  - 44
IP  - 8
4099  - http://www.ajnr.org/content/44/8/928.short
4100  - http://www.ajnr.org/content/44/8/928.full
SO  - Am. J. Neuroradiol.2023 Aug 01; 44
AB  - 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.EVTendovascular treatmentHPRhigh on-treatment platelet reactivityIAintracranial aneurysmLTAlight transmission aggregometryPFTplatelet function testingRCTrandomized controlled trial