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Variable responsiveness to clopidogrel and aspirin among patients with acute coronary syndrome as assessed by

Boris Shenkman1, Shlomi Matetzky, Paul Fefer

  • 1Amalia Biron Research Institute of Thrombosis and Hemostasis, Israel.

Thrombosis Research
|December 25, 2007
PubMed

Insights

Platelet aggregometry and Impact-R effectively detect unresponsiveness to clopidogrel and aspirin in acute coronary syndrome patients. Both methods showed similar results in identifying non-responding patients to these antiplatelet therapies.

Area of Science:

  • Cardiology
  • Hematology
  • Clinical Chemistry

Background:

  • Unresponsiveness to clopidogrel and aspirin is a concern in acute coronary syndrome (ACS) patients.
  • Accurate detection of antiplatelet therapy non-response is crucial for patient outcomes.

Purpose of the Study:

  • To compare the efficacy of Platelet Aggregometry (PA) and Impact-R (Cone and Plate(let) Analyzer technology) in detecting laboratory non-responsiveness to clopidogrel and aspirin in ACS patients.
  • To establish cut-off values for Impact-R in identifying non-responding patients.

Main Methods:

  • 404 ACS patients were evaluated using PA (adenosine diphosphate [ADP] and arachidonic acid [AA]) and Impact-R (ADP- and AA-response tests).
  • Laboratory non-response definitions were established for both methods.
  • Receiver operating characteristic curve analysis was used to determine Impact-R cut-off values.

Main Results:

  • The incidence of non-responsiveness was 27% for clopidogrel and 22% for aspirin across methods.
  • Impact-R showed high agreement (79-82%), sensitivity (71-73%), and specificity (83-86%) compared to PA.
  • Specific Impact-R surface coverage cut-offs were identified: <=2.8% for clopidogrel and <=3.4% for aspirin non-response.

Conclusions:

  • The Impact-R system demonstrates a high degree of similarity to PA in detecting laboratory non-responsiveness to clopidogrel and aspirin in ACS patients.
  • Impact-R offers a reliable alternative for assessing antiplatelet therapy response in this patient population.

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