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

Thomas Gremmel1, Sabine Steiner, Daniela Seidinger

  • 1Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. thomas.gremmel@meduniwien.ac.at

Thrombosis and Haemostasis
|February 5, 2009
PubMed

Insights

High residual platelet reactivity after clopidogrel treatment increases adverse outcomes post-percutaneous coronary intervention (PCI). The VerifyNow P2Y12 assay best correlates with light transmission aggregometry (LTA) for assessing platelet inhibition, though further standardization is needed.

Area of Science:

  • Cardiology
  • Pharmacology
  • Biomedical Engineering

Background:

  • Residual on-treatment platelet reactivity, particularly ADP-inducible reactivity measured by light transmission aggregometry (LTA), is linked to adverse events following percutaneous coronary intervention (PCI).
  • Light transmission aggregometry (LTA) lacks standardization, leading to variability in results across different laboratories.
  • Assessing clopidogrel's effectiveness in inhibiting platelet aggregation is crucial for managing patients post-PCI.

Purpose of the Study:

  • To identify the most reliable laboratory assay for estimating clopidogrel-mediated platelet inhibition by comparing its correlation with LTA.
  • To evaluate four different platelet function assays against LTA in patients undergoing PCI.

Main Methods:

  • Eighty patients on dual antiplatelet therapy post-elective PCI with stent implantation were included.
  • Four assays—VerifyNow P2Y12, vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay, multiple electrode platelet aggregometry (MEPA), and Impact-R—were compared with LTA.
  • Cut-off values were determined by assay quartiles, with sensitivities and specificities calculated based on LTA results.

Main Results:

  • All four tested assays demonstrated a significant correlation with LTA.
  • The VerifyNow P2Y12 assay exhibited the strongest correlation with LTA (r = 0.61, p < 0.001).
  • Sensitivities and specificities for the assays ranged from 35% to 55% and 78.3% to 85%, respectively.

Conclusions:

  • While all evaluated assays correlate with LTA, none are sufficiently refined for routine clinical diagnostic use.
  • Further research and standardization are necessary to establish a gold standard method for assessing residual ADP-inducible platelet reactivity and universally accepted cut-off values.

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