Genotype-guided antiplatelet treatment versus conventional therapy: A systematic review and meta-analysis

Link to article at PubMed

Br J Clin Pharmacol. 2020 Nov 3. doi: 10.1111/bcp.14637. Online ahead of print.

ABSTRACT

AIM: This meta-analysis was carried out to explore if a personalized antiplatelet strategy based on genotyping is superior to conventional therapy.

METHODS: PubMed, Web of Science, EMBASE, and the Cochrane Library were searched from the inception of each database to May 5, 2020. Studies reporting endpoints in genotype-guided treatment group and conventional treatment group were included. The endpoint results were presented as the risk ratio (RR), with 95 % confidence interval (CI).

RESULTS: A total of 10,561 patients from 16 studies (8 randomized controlled trials [RCT] and 8 cohort studies) were included in the meta-analysis. The rates of major adverse cardiovascular events (MACE), stent thrombosis, and myocardial infarction (MI) were significantly lower in the genotype-guided group than in the conventional treatment group (RR: 0.56, 95 % CI: 0.44-0.73, p < 0.0001; RR: 0.40, 95 % CI: 0.24-0.67, p = 0.0005; RR: 0.45, 95 % CI: 0.35-0.58, p < 0.00001, respectively). A significant difference was found between the two groups in major bleeding (RR: 0.73, 95 % CI: 0.55-0.98, p = 0.04), which was not robust after sensitivity analysis.

CONCLUSION: Genotype-guided antiplatelet treatment could decrease the risk of MACE, stent thrombosis, and MI in patients with coronary artery disease or undergoing PCI, without increasing the risk of bleeding over a long follow-up period. The decreased risk of efficacy outcomes was more obvious in cohort studies. Well-organized RCTs and clinical trials are required to verify the benefit of genotype-guided therapy.

PMID:33140858 | DOI:10.1111/bcp.14637

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