Comparison of methods for monitoring residual platelet reactivity after clopidogrel by point-of-care tests on whole blood in high-risk patients

• Published in: Thrombosis and haemostasis Vol. 104; no. 2; p. 287
• Main Authors: Paniccia, Rita, Antonucci, Emilia, Maggini, Niccolò, Miranda, Marco, Gori, Anna Maria, Marcucci, Rossella, Giusti, Betti, Balzi, Daniela, Prisco, Domenico, Abbate, Rosanna
• Format: Journal Article
• Language: English
• Published: Germany 01.08.2010
• Subjects: Adenosine Diphosphate; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Blood Platelets - drug effects; Blood Platelets - metabolism; Coronary Artery Disease - blood; Coronary Artery Disease - drug therapy; Coronary Artery Disease - therapy; Drug Monitoring - methods; Female; Humans; Italy; Male; Middle Aged; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Function Tests; Point-of-Care Systems; Predictive Value of Tests; Receptors, Purinergic P2Y12 - blood; Receptors, Purinergic P2Y12 - drug effects; Registries; Reproducibility of Results; Risk Assessment; Risk Factors; Stents; Thrombosis - blood; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome; Italy
• ISSN: 0340-6245
• DOI: 10.1160/TH09-12-0832

Cardiovascular events are more frequent in high-risk coronary artery disease (CAD) patients on dual antiplatelet therapy with a residual platelet reactivity (RPR) than in those showing inhibition of ADP-inducible platelet activation. It is known that post-interventional RPR is a clinically important entity confirming it as a risk factor for thrombo-ischaemic events. Multiple electrode platelet aggregometry (MEA) on whole blood has been recently proposed as a rapid tool to evaluate RPR in high-risk CAD patients on clopidogrel therapy. It was the aim of this study to detect RPR in 801 high-risk CAD patients on dual antiplatelet therapy comparing MEA with the VerifyNow P2Y12 assay on whole blood and classical light transmission aggregation (LTA) on platelet-rich plasma. ADP (10 microM) was employed as agonist for MEA and LTA. The prevalence of RPR was 20.6% by MEA, 16.1% by LTA and 30.8% by VerifyNow. MEA showed a significant correlation (rho=0.62, p<0.0001) with VerifyNow and a moderate agreement (k=0.52, p<0.001) with 81.5% of concordant values. A significant correlation was found between MEA and LTA (rho=0.71, p<0.001) with a good agreement (k=0.63, p<0.001) and 88.8% of concordant values. MEA in relation to LTA showed a sensitivity of 80% and a specificity of 91%. MEA might represent a reliable method and valid alternative in comparison with other available platelet function assays. It might help to guide antiplatelet therapy and thus improve clinical outcome of high-risk CAD patients.