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Comparison of methods to evaluate clopidogrel-mediated platelet inhibition after percutaneous intervention with stent implantation

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Thrombotic microangiopathies: New developments and translation into medicine

DOI: http://dx.doi.org/10.1160/TH08-09-0577
Issue: 2009: 101/2 (Feb) pp. 217-412
Pages: 333-339

Comparison of methods to evaluate clopidogrel-mediated platelet inhibition after percutaneous intervention with stent implantation

Thomas Gremmel1; Sabine Steiner1; Daniela Seidinger1; Renate Koppensteiner1; Simon Panzer2*; Christoph W. Kopp1*
1 Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; 2 Clinical Department for Blood Group Serology, Medical University of Vienna, Vienna, Austria

Keywords

platelet aggregation, platelet function tests, Antiplatelet agents

Summary

A high on-treatment residual ADP-inducible platelet reactivity in light transmission aggregometry (LTA) has been associated with an increased risk of adverse outcomes after percutaneous coronary intervention (PCI). However, LTA is weakly standardized, and results obtained in one laboratory may not be comparable to those obtained in another one. We therefore sought to determine the test correlating best with LTA to estimate clopidogrelmediated platelet inhibition in 80 patients on dual antiplatelet therapy after elective percutaneous intervention with stent implantation. We selected the VerifyNow P2Y12 assay, the vasodilator- stimulated phosphoprotein phosphorylation assay, multiple electrode platelet aggregometry and the Impact-R for comparisons with LTA. Cut-off values for residual ADP-inducible platelet reactivity were defined according to quartiles of each assay. Sensitivities and specificities of the different platelet function tests were based on the results from LTA. The results from all four assays correlated significantly with those from LTA. The VerifyNow P2Y12 assay revealed the strongest correlation (r = 0.61, p < 0.001). Sensitivities and specificities ranged from 35% to 55%, and from 78.3% to 85%, respectively. In conclusion, although all assays correlated significantly with LTA, they need to be improved to become clinically used diagnostic tests. Further, it may be too early to define the gold standard method for assessing residual ADP-inducible platelet reactivity and generally acceptable cut-off values.

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