Dual Antiplatelet Therapy Monitoring for Neurointerventional Procedures Using a Point-of-Care Platelet Function Test: A Single-Center Experience

SummaryPatients with chronic kidney disease (CKD) have an increased risk of cardiovascular disease. Previous studies have suggested that patients with CKD have less therapeutic benefit of antiplatelet therapy. However, the relation between renal function and platelet reactivity is still under debate. On-treatment platelet reactivity was determined in parallel by ADP- and AA-induced light transmittance aggregometry (LTA) and the VerifyNow® System (P2Y12 and Aspirin) in 988 patients on dual antiplatelet therapy, undergoing elective coronary stenting. Patients were divided into two groups according to the presence or absence of moderate/severe CKD (GFR<60 ml/min/1.73 m2). Furthermore, the incidence of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and stroke at one-year was evaluated. Patients with CKD (n=180) had significantly higher platelet reactivity, regardless of the platelet function test used. Patients with CKD more frequently had high on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) regardless of the platelet function test used. After adjustment for potential confounders, this was no longer significant. The event-rate was the highest in patients with both high on-treatment platelet reactivity (HPR) and CKD compared to those with neither high on-treatment platelet reactivity nor CKD. In conclusion, the magnitude of platelet reactivity as well as the incidence of HPR was higher in patients with CKD. However, since the incidence of HPR was similar after adjustment, a higher rate of co-morbidities in patients with CKD might be the major cause for this observation rather than CKD itself. CKD-patients with HCPR were at the highest risk of long-term cardiovascular events.Clinical Trial Registration: www.clinicaltrials.gov: NCT00352014.

Download Full-text

Analysis of Platelet Function from Thromboelastography Examination in Patients with Single and Multiple Antiplatelet Therapy after Percutaneous Coronary Intervention in Dr. Saiful Anwar Malang

Research Journal of Life Science ◽

10.21776/ub.rjls.2020.007.01.3 ◽

2020 ◽

Vol 7 (1) ◽

pp. 19-28

Author(s):

Sasmojo Widito ◽

Dadang Hendrawan ◽

Dedy Irawan

Keyword(s):

Percutaneous Coronary Intervention ◽

Antiplatelet Therapy ◽

Platelet Function ◽

Dual Antiplatelet Therapy ◽

Coronary Intervention ◽

Primary Therapy ◽

Research Subjects ◽

Platelet Function Test ◽

Percutaneous Coronary ◽

Significant Difference

Each year, approximately 3 million people with coronary heart disease worldwide undergo percutaneous coronary intervention (PCI). Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors became the primary therapy for 6-12 months after PCI. DAPT can be continued > 12 months at a high risk of thrombosis. About 9-10% of patients with dual antiplatelet therapy still experience ischemia. The platelet function examination by thromboelastography (TEG). This research is an analytic observational study using a cross-sectional method. This study was conducted in Saiful Anwar General Hospital. Patients were divided into two groups: (1) on-single antiplatelet therapy; (2) on-dual antiplatelet therapy. The outcome measured result of the platelet function test was divided into standard, low platelet function, and platelet hypercoagulability. An analysis of the differences between single or multiple antiplatelet administration and the platelet function results was performed. There were 52 research subjects, each group of single and multiple antiplatelet therapies as many as 26 people, most of the subjects were male (82.6%) with a mean age of 57. The results of this study showed that there was no significant difference in the results of platelet function examinations between single and multiple antiplatelet therapies after 12 months of dual antiplatelet therapy.

Download Full-text

Dual antiplatelet therapy after percutaneous left atrial appendage occlusion: single center experience with the Amplatzer Cardiac Plug

Acta Cardiologica ◽

10.1080/00015385.2018.1455946 ◽

2018 ◽

Vol 74 (1) ◽

pp. 74-81 ◽

Cited By ~ 3

Author(s):

Philippe B. Bertrand ◽

Melanie Habran ◽

Karlijn Kenis ◽

Julie Lecomte ◽

Linde Moonen ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Left Atrial ◽

Left Atrial Appendage ◽

Dual Antiplatelet Therapy ◽

Atrial Appendage ◽

Single Center ◽

Single Center Experience ◽

Left Atrial Appendage Occlusion

Download Full-text

Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy

Thrombosis Journal ◽

10.1186/1477-9560-6-1 ◽

2008 ◽

Vol 6 (1) ◽

pp. 1 ◽

Cited By ~ 19

Author(s):

Alex R Hobson ◽

Graham Petley ◽

Geraint Morton ◽

Keith D Dawkins ◽

Nick P Curzen

Keyword(s):

Antiplatelet Therapy ◽

Stent Thrombosis ◽

Platelet Function ◽

Dual Antiplatelet Therapy ◽

Point Of Care ◽

Drug Eluting Stent ◽

Drug Eluting ◽

Platelet Function Assays

Download Full-text

Optimal platelet function test for in-stent tissue protrusion following carotid artery stenting

Journal of International Medical Research ◽

10.1177/0300060518762949 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1866-1875 ◽

Cited By ~ 2

Author(s):

Masanori Tsujimoto ◽

Yukiko Enomoto ◽

Masafumi Miyai ◽

Yusuke Egashira ◽

Toru Iwama

Keyword(s):

Carotid Artery ◽

Platelet Function ◽

Carotid Artery Stenting ◽

Platelet Reactivity ◽

Point Of Care ◽

Adenosine Diphosphate ◽

Light Transmittance ◽

Projection Area ◽

Platelet Function Test ◽

Function Test

Purpose To determine the best platelet function test for in-stent tissue protrusion following carotid artery stenting (CAS). Methods Patients who underwent CAS were recruited prospectively in this observational study. Combination of aspirin 100 mg/day and clopidogrel 75 mg/day was administered for a minimum of 7 days prior to procedure. Platelet aggregation was measured by light transmittance aggregometry (LTA) following stimulation by adenosine diphosphate (ADP), collagen, and thrombin receptor activating peptide (TRAP) and by the point of care assay, VerifyNow which measures aspirin and thienopyridine reaction units. Results In-stent tissue protrusion with maximum projection area of ≥1 mm2 was detected by optical coherence tomography (OCT) in 10/28 (36%) patients. Baseline characteristics were not significantly different between the two in-stent size groups (i.e., ≥1 mm2 vs. <1 mm2) but after stimulation by collagen at 10 and 20 μg/ml, platelet reactivity as measured by LTA was significantly higher in the ≥1 mm2 group compared with the <1 mm2 group. No other differences in platelet function were detected. Conclusions Collagen-induced platelet reactivity was related to in-stent tissue protrusion size following CAS.

Download Full-text

Correlation between PlateletWorks® and PFA-100® for Measuring Platelet Function before Urgent Surgery in Patients with Chronic Antiplatelet Therapy

Journal of Clinical Medicine ◽

10.3390/jcm10020255 ◽

2021 ◽

Vol 10 (2) ◽

pp. 255

Author(s):

Rafael Anaya ◽

Mireia Rodriguez ◽

José María Gil ◽

Noelia Vilalta ◽

Angela Merchan-Galvis ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Platelet Function ◽

Point Of Care ◽

Antiplatelet Agents ◽

Kappa Coefficient ◽

Function Evaluation ◽

Cohen’S Kappa ◽

Platelet Function Test ◽

Cohen's Kappa ◽

Cohen’S Kappa Coefficient

Hemostasis is crucial for reducing bleeding during surgical procedures. The points-of-care based on the platelet function test could be useful to minimize the complications related to chronic antiplatelet therapy during surgery. The present study is aimed at comparing two point-of-care platelet function devices—Platelet Function Analyzer PFA-100® (Siemens Canada, Mississauga, ON, Canada) and Plateletworks®(Helena Laboratories, Beaumont, TX, USA). Our objective is to evaluate if they provide comparable and useful information to manage anti-aggregate patients before surgery. We included patients with a femoral fracture receiving chronic antiplatelet therapy and a median age of 89 years (range from 70 to 98). A platelet function evaluation was performed on all patients before surgery using both devices—Plateletworks® and PFA-100®. The correlation between Plateletworks® and PFA-100® was performed using Cohen’s Kappa coefficient. Twenty consecutive patients participated in the trial; 16 patients were under treatment with 75 mg/day of clopidogrel, three with >300 mg/day of acetylsalicylic acid (ASA), and only one was in treatment with both antiplatelet agents. Cohen’s Kappa coefficient was 0.327 comparing PFA-100®-ADP (adenosine diphosphate) and Plateletworks® and, 0.200 comparing PFA-100®-EPI (epinephrine) and Plateletworks®. In conclusion, we found a weak concordance comparing PFA-100® and Plateletworks®. This could partially be due to the advanced age of the included patients. However, given the limited sample size, more studies are necessary to confirm these results.

Download Full-text

How I use laboratory monitoring of antiplatelet therapy

Blood ◽

10.1182/blood-2017-03-742338 ◽

2017 ◽

Vol 130 (6) ◽

pp. 713-721 ◽

Cited By ~ 22

Author(s):

Alan D. Michelson ◽

Deepak L. Bhatt

Keyword(s):

Antiplatelet Therapy ◽

Platelet Function ◽

Molecular Targets ◽

Antiplatelet Agents ◽

Clinical Settings ◽

Platelet Function Test ◽

Function Test ◽

Artery Disease ◽

Proven Benefit ◽

Guided Therapy

Abstract Antiplatelet therapy is of proven benefit in coronary artery disease and a number of other clinical settings. This article reviews platelet function, molecular targets of antiplatelet agents, and clinical indications for antiplatelet therapy before focusing on a frequent question to hematologists about the 2 most commonly used antiplatelet therapies: Could the patient be aspirin “resistant” or clopidogrel “resistant”? If so, should results of a platelet function test be used to guide the dose or type of antiplatelet therapy? Whether such guided therapy is of clinical benefit to patients has been a source of controversy. The present article reviews this subject in the context of 2 prototypical clinical cases. Available evidence does not support the use of laboratory tests to guide the dose of aspirin or clopidogrel in patients with so-called aspirin or clopidogrel “resistance.”

Download Full-text