RT Journal Article T1 Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis. A1 Lim, Soon Tjin A1 Thijs, Vincent A1 Murphy, Stephen J X A1 Fernandez-Cadenas, Israel A1 Montaner, Joan A1 Offiah, Chika A1 Marquardt, Lars A1 Kelly, Peter J A1 Bath, Philip M A1 Lim, Su-Yin A1 Ford, Gary A A1 Norrving, Bo A1 Cox, Dermot A1 Prodan, Calin I A1 Barber, Philip A A1 Werring, David J A1 Perry, Richard A1 Zgaga, Lina A1 Dawson, Jesse A1 McCabe, Dominick J H K1 Ischaemic stroke K1 Meta-analysis K1 Platelet function/on-treatment platelet reactivity K1 Systematic review K1 Transient ischaemic attack AB The prevalence of ex vivo 'high on-treatment platelet reactivity (HTPR)' and its relationship with recurrent vascular events/outcomes in patients with ischaemic cerebrovascular disease (CVD) is unclear. A systematic review and meta-analysis was performed in accordance with the PRISMA statement. MEDLINE, EMBASE and Cochrane Library were searched for completed manuscripts until May 2019 on TIA/ischaemic stroke patients, ≥ 18 years, treated with commonly-prescribed antiplatelet therapy, who had platelet function/reactivity testing and prospective follow-up data on recurrent stroke/TIA, myocardial infarction, vascular death or other cerebrovascular outcomes. Data were pooled using random-effects meta-analysis. Primary outcome was the composite risk of recurrent stroke/TIA, myocardial infarction or vascular death. Secondary outcomes were recurrent stroke/TIA, severe stroke (NIHSS > 16) or disability/impairment (modified Rankin scale ≥ 3) during follow-up. Antiplatelet-HTPR prevalence was 3-65% with aspirin, 8-56% with clopidogrel and 1.8-35% with aspirin-clopidogrel therapy. Twenty studies (4989 patients) were included in our meta-analysis. There was a higher risk of the composite primary outcome (OR 2.93, 95% CI 1.90-4.51) and recurrent ischaemic stroke/TIA (OR 2.43, 95% CI 1.51-3.91) in patients with vs. those without 'antiplatelet-HTPR' on any antiplatelet regimen. These risks were also more than twofold higher in patients with vs. those without 'aspirin-HTPR' and 'dual antiplatelet-HTPR', respectively. Clopidogrel-HTPR status did not significantly predict outcomes, but the number of eligible studies was small. The risk of severe stroke was higher in those with vs. without antiplatelet-HTPR (OR 2.65, 95% CI 1.00-7.01). Antiplatelet-HTPR may predict risks of recurrent vascular events/outcomes in CVD patients. Given the heterogeneity between studies, further prospective, multi-centre studies are warranted. PB Springer Medizin YR 2020 FD 2020-10 LK http://hdl.handle.net/10668/15715 UL http://hdl.handle.net/10668/15715 LA en NO Lim ST, Thijs V, Murphy SJX, Fernandez-Cadenas I, Montaner J, Offiah C, et al. Platelet function/reactivity testing and prediction of risk of recurrent vascular events and outcomes after TIA or ischaemic stroke: systematic review and meta-analysis. J Neurol. 2020 Oct;267(10):3021-3037. DS RISalud RD May 11, 2025