A head-to-head comparison between the VerifyNow®P2Y12 assay and light transmittance aggregometry for monitoring the individual platelet response to clopidogrel in patients undergoing elective percutaneous coronary intervention

AbstractHigh on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine disdiphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

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Association of Frailty With Antiplatelet Response Among Elderly Chinese Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620915994 ◽

2020 ◽

Vol 26 ◽

pp. 107602962091599

Author(s):

Yang Liu ◽

Shaoyan Liu ◽

Keyu Wang ◽

Hongbin Liu

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Elderly Patients ◽

Independent Predictor ◽

Coronary Intervention ◽

Light Transmittance ◽

Platelet Response ◽

Percutaneous Coronary ◽

Artery Disease

Frailty has been implicated as a prognostic factor for ischemic cardiovascular diseases. However, the effects of frailty on platelet responses to aspirin and clopidogrel remain under investigation. In this study, we enrolled consecutive elderly patients with coronary artery disease (CAD) who were treated by percutaneous coronary intervention (PCI) to evaluate this association. A total of 264 patients (aged 70-95 years) were included. Patients were divided into 2 groups: a nonfrail (nFR) group and a frail (FR) group according to the Clinical Frailty Scale. Platelet reactivity was assessed with a light transmittance aggregometry method, and arachidonic acid and adenosine diphosphate induced maximum platelet aggregation (AA-MPA/ADP-MPA) were calculated to evaluate the platelet response to aspirin and clopidogrel. The results showed that the AA-MPA and ADP-MPA of the FR group were significantly higher than those in the nFR group (17.49 ± 6.65 vs 15.19 ± 6.33, P < .01; 56.13 ± 10.14 vs 45.45 ± 11.59, P < .01). High on-aspirin platelet response (HAPR) and high on-clopidogrel platelet response (HCPR) were significantly more common in the FR group than in the nFR group (24.67% vs 13.16%, P = .028, 37.33% vs 15.79%, P < .01). According to multivariable regression analyses, frailty was found to be independently associated with AA-MPA (βcoefficient = 1.883, P = .042) and ADP-MPA (βcoefficient = 9.287, P < .001), and it was an independent predictor of HAPR (odds ratio [OR]: 2.696, P < .01) and HCPR (OR: 2.543, P < .01). It was concluded that among elderly patients with CAD undergoing PCI, frailty is an independent predictor of HAPR and HCPR, and the state of frailty is independently associated with the platelet responses to clopidogrel and aspirin.

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Do not adjust the platelet count in light transmittance aggregometry when predicting thrombotic events after percutaneous coronary intervention

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2010.04003.x ◽

2010 ◽

Vol 8 (10) ◽

pp. 2326-2328 ◽

Cited By ~ 6

Author(s):

N. J. BREET ◽

J. W. VAN WERKUM ◽

H. J. BOUMAN ◽

J. C. KELDER ◽

J. M. TEN BERG ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Platelet Count ◽

Coronary Intervention ◽

Light Transmittance ◽

Percutaneous Coronary ◽

Light Transmittance Aggregometry

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Use of Thromboelastography Platelet Mapping for Assessment of Individual Platelet Response Secondary to Oral Antiplatelet Therapy after Percutaneous Coronary Intervention: An Attempt to Start Personalized Antiplatelet Therapy in India

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1735667 ◽

2021 ◽

Vol 5 (02) ◽

pp. 108-113

Author(s):

Suvro Sankha Datta ◽

Dibyendu De ◽

Nadeem Afroz Muslim

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Platelet Reactivity ◽

Adenosine Diphosphate ◽

Coronary Intervention ◽

Platelet Inhibition ◽

P Value ◽

Platelet Response ◽

Percutaneous Coronary ◽

The Individual

AbstractHigh on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine diphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

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