Predicting ischaemic events using platelet reactivity in patients receiving clopidogrel: indirect meta‐comparison among VerifyNow, light‐transmission aggregometry and thromboelastography

: The present study compared performances of the 3 major methods used for assessing platelet reactivity (PR)-VerifyNow, light-transmission aggregometry (LTA), and thromboelastography (TEG)-to predict ischaemic events in patients receiving clopidogrel. PubMed, EmBase and the Cochrane library were searched from their inception to April 2019 for prospective studies that examined PR using VerifyNow, LTA or TEG and the incidence of ischaemic events. The investigated diagnostic indices including sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio, and area under the receiver operating characteristic curves (AUC) of VerifyNow, LTA, and TEG, respectively. A total of 26 prospective studies involving 22,185 subjects were included in the analysis. The pooled AUC was 0.71 (95% CI: 0.67-0.75) for VerifyNow, 0.60 (95% CI: 0.55-0.64) for LTA, and 0.81 (95% CI: 0.77-0.84) for TEG. Results of indirect comparisons indicated the AUC of VerifyNow was higher than that of LTA (1.18, 95% CI: 1.08-1.30) and lower than that of TEG (0.88, 95% CI: 0.82-0.94). TEG outperformed the other 2 methods for assessing PR in all predictive measures, including sensitivity, specificity, PLR, and NLR. Despite a lack of studies that directly compared the 3 methods, our findings suggest that TEG should be recommended.