Platelet Function Testing and Clinical Outcomes in Peripheral Arterial Disease: Systematic Review and Narrative Synthesis
Journal of Vascular Surgery
Objective: This systematic review aims to comprehensively assess the contemporary literature on platelet function testing (PFT) in individuals undergoing revascularization therapy for peripheral arterial disease (PAD). The goal is to identify whether PFT can aid in detecting antiplatelet resistance, predicting post-procedural thrombotic complications, and informing tailored treatment strategies.
Methods: Following PRISMA guidelines, a literature review was conducted using PubMed databases. Search terms included relevant medical subject headings (MeSH) terms. Eligible articles published in English between 1990 and 2023 were analyzed. Studies that examined PFT outcomes in PAD patients after lower extremity revascularization were included.
Results: Ten studies met the inclusion criteria. Various PFT methods were used, including Thromboelastography with Platelet Mapping (TEG-PM), Multiplate Analyzer, Cytochrome P450 2C19 testing, VerifyNow, Corrected Whole Blood Aggregometry, Platelet Function Analyzer (PFA)-100, and Light Transmission Aggregometry (LTA). PFT identified individuals who were resistant or non-sensitive to antiplatelet therapy, with such patients facing increased risks of graft/stent thrombosis, amputation, and reintervention. However, substantial heterogeneity in surgical procedures, drug regimens, and testing methods was observed among the studies.
Conclusion: PFTs can play a crucial role in detecting resistance and non-sensitivity to antiplatelet drugs in PAD patients post-revascularization. However, heterogeneity of data and methods underlines the need for standardized protocols and consensus-building among PFTs. Enhancing clinical utility and reliability could help optimize antiplatelet thromboprophylaxis, minimize thrombotic complications, and improve treatment strategies in vascular surgery. Further research is necessary to solidify the role of PFTs in guiding antiplatelet therapy post-revascularization in PAD patients.
Antiplatelet resistance, Peripheral arterial disease, Platelet function testing, Revascularization
Kankaria A, Majumdar M, Lee S, Hall RP, Suarez Ferreira SP, Lee I, Patel S, Jessula S, Gerardo D'Oria MG, Dua A. Platelet Function Testing and Clinical Outcomes in Peripheral Arterial Disease: Systematic Review and Narrative Synthesis. Journal of Vascular Surgery. 2023; . doi: 10.1016/j.jvs.2023.12.028.