Supplementary Material for: Thromboelastography-guided antiplatelet therapy for patients with ischemic cerebrocardiovascular diseases: a systematic review and meta-analysis

Background: The effectiveness of thromboelastography (TEG)-guided antiplatelet therapy in patients with ischemic cerebrocardiovascular diseases is not well-established. This systematic review evaluates the efficacy and safety of TEG-guided antiplatelet therapy compared to standard treatment in patients with ischemic cerebrocardiovascular diseases. Methods: Randomized controlled trials (RCTs) and observational studies comparing TEG-guided antiplatelet therapy with standard therapy in patients suffering from ischemic stroke (IS) or coronary artery disease (CAD) were identified. The primary efficacy measure was a composite of ischemic and hemorrhagic events. Secondary efficacy measures included any ischemic events, while safety was assessed by the occurrence of bleeding events. Results: 10 studies involving 4 RCTs and 6 observational studies with a total of 1,678 patients were included. When considering a composite of ischemic and hemorrhagic events in RCTs, a significant reduction was observed in IS or CAD patients under TEG-guided therapy compared to standard therapy (OR 0.45, 95% CI 0.27 to 0.75, P=0.002). After pooling RCTs and observational studies together, compared to standard antiplatelet therapy, TEG-guided therapy significantly reduced the risk of a composite of ischemic and hemorrhagic events (OR 0.26, 95% CI 0.19 to 0.37; P<0.00001), ischemic events (OR 0.28, 95% CI 0.19 to 0.41; P<0.00001), and bleeding events (OR 0.31, 95% CI 0.16 to 0.62; P=0.0009) in patients with IS or CAD. Conclusions: TEG-guided antiplatelet therapy appears to be both effective and safe for patients with IS or CAD. These findings support the use of TEG testing to tailor antiplatelet therapy in individuals with ischemic cerebrocardiovascular diseases.

背景：血栓弹力图（thromboelastography, TEG）指导下的抗血小板治疗在缺血性心脑血管疾病患者中的疗效尚未明确。本系统评价旨在评估缺血性心脑血管疾病患者采用TEG指导的抗血小板治疗相较于标准治疗的有效性与安全性。

方法：本研究检索了针对缺血性卒中（ischemic stroke, IS）或冠状动脉粥样硬化性心脏病（coronary artery disease, CAD）患者，对比TEG指导的抗血小板治疗与标准治疗的随机对照试验（randomized controlled trials, RCTs）及观察性研究。本研究的主要有效性终点为缺血与出血事件复合终点，次要有效性终点包含任意缺血事件，安全性则通过出血事件的发生情况进行评估。

结果：本研究共纳入10项研究，包含4项RCTs与6项观察性研究，总计1678例患者。在仅纳入RCTs的分析中，相较于标准治疗，IS或CAD患者接受TEG指导的治疗后，缺血与出血事件复合终点的发生风险显著降低（比值比（odds ratio, OR）=0.45，95%置信区间（95% confidence interval, CI）：0.27~0.75，P=0.002）。合并RCTs与观察性研究进行整体分析后，相较于标准抗血小板治疗，TEG指导的治疗可显著降低IS或CAD患者的缺血与出血事件复合终点风险（OR=0.26，95%CI：0.19~0.37；P<0.00001）、缺血事件风险（OR=0.28，95%CI：0.19~0.41；P<0.00001）及出血事件风险（OR=0.31，95%CI：0.16~0.62；P=0.0009）。

结论：对于IS或CAD患者，TEG指导的抗血小板治疗兼具有效性与安全性。本研究结果支持采用TEG检测为缺血性心脑血管疾病患者制定个体化抗血小板治疗方案。