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Thromb Haemost 2010; 104(02): 587-292
DOI: 10.1160/TH09-12-0832
Platelets and Blood Cells
Schattauer GmbH

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

Rita Paniccia
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
,
Emilia Antonucci
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
,
Niccolò Maggini
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
3   Fondazione Don Carlo Gnocchi ONLUS, Centro S. Maria degli Ulivi-IRCCS, Florence, Italy
,
Marco Miranda
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
,
Anna Maria Gori
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
3   Fondazione Don Carlo Gnocchi ONLUS, Centro S. Maria degli Ulivi-IRCCS, Florence, Italy
,
Rossella Marcucci
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
,
Betti Giusti
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
,
Daniela Balzi
4   Epidemiology Unit, Azienda Sanitaria Firenze, Florence, Italy
,
Domenico Prisco
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
,
Rosanna Abbate
1   Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Italy
2   Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Italy
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Publikationsverlauf

Received: 11. Dezember 2009

Accepted after resubmission: 12. März 2010

Publikationsdatum:
24. November 2017 (online)

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Summary

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-is-chaemic 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 plateletrich plasma. ADP (10 μM) 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.

Keywords

Clopidogrel therapy - light transmission aggregometry - multiple elec-trode aggregometry - point-of-care testing - residual platelet reactivity
 

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