Lim, Soon TjinThijs, VincentMurphy, Stephen J XFernandez-Cadenas, IsraelMontaner, JoanOffiah, ChikaMarquardt, LarsKelly, Peter JBath, Philip MLim, Su-YinFord, Gary ANorrving, BoCox, DermotProdan, Calin IBarber, Philip AWerring, David JPerry, RichardZgaga, LinaDawson, JesseMcCabe, Dominick J H2023-02-092023-02-092020-10Lim 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.http://hdl.handle.net/10668/15715The 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.enIschaemic strokeMeta-analysisPlatelet function/on-treatment platelet reactivitySystematic reviewTransient ischaemic attackBrain IschemiaHumansIschemic Attack, TransientIschemic StrokePlatelet Aggregation InhibitorsStrokeresearch article32518978Restricted AccessPacientesAccidente cerebrovascularTerapéuticaAspirinaMetaanálisisClopidogrelPlaquetasInfarto del miocardioPrevalenciaTrastornos cerebrovasculares10.1007/s00415-020-09932-y1432-1459https://nottingham-repository.worktribe.com/preview/4631308/Platelet%20fxn%20in%20TIA-Stroke%20-%20SR-MA%20J%20Neurol%20-%20CO-DMcC%20submitted%2027-04-20.pdf