Sequential ADP-stimulated light transmission and multiple electrode aggregometry in patients taking aspirin and
Oystein Meen1, Frank Brosstad, Knut Liestøl
1Department of Medicine, Kongsberg Hospital, Vestre Viken HF, Norway.
Insights
Multiple electrode aggregometry (MEA) and light transmission aggregometry (LTA) show moderate variability in clopidogrel responsiveness over time. The agreement between MEA and LTA for identifying high platelet reactivity is good and stable in patients with non-ST elevation myocardial infarction.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Pharmacology
Background:
- Fast platelet function tests are crucial for identifying patients with non-ST elevation myocardial infarction (NSTEMI) who are weak responders to clopidogrel therapy.
- Limited data exist on the long-term variability of clopidogrel responsiveness and the agreement between different aggregometry methods in clinical practice.
Purpose of the Study:
- To investigate the long-term variability of multiple electrode aggregometry (MEA) measurements in patients with NSTEMI treated with aspirin and clopidogrel.
- To assess the agreement between MEA and light transmission aggregometry (LTA) in evaluating platelet function over a 12-week period.
Main Methods:
- Parallel MEA and LTA assays were conducted at baseline, 6 weeks, and 12 weeks in 31 NSTEMI patients post-percutaneous coronary intervention.
- Tests utilized adenosine diphosphate (ADP) at concentrations of 2 μM, 6.5 μM, and 10 μM in both arterial and venous blood samples.
- High platelet reactivity (HPR) was determined using established cut-off levels for both MEA and LTA.
Main Results:
- Arterial and venous aggregometry measurements by MEA and LTA showed similar results.
- Within-subject variability in platelet aggregation was moderate for both MEA and LTA over the 12-week study period.
- An 87.1% agreement in HPR classification was observed between MEA and LTA, with agreement improving from baseline to 12 weeks.
Conclusions:
- MEA and LTA demonstrate similar performance in assessing platelet aggregation in both arterial and venous blood.
- Platelet responsiveness to clopidogrel exhibits moderate within-subject variability over time.
- The agreement between MEA and LTA is good and remains stable for most patients, supporting their use in clinical settings.
Background:
Fast platelet function tests can identify weak clopidogrel responders, but data on variability over time in clopidogrel responsiveness in several clinical settings are lacking. We wanted to explore long-term variability of multiple electrode aggregometry (MEA) measurements and the agreement between MEA and light transmission aggregometry (LTA) in patients with non-ST elevation myocardial infarction (NSTEMI) treated with aspirin and clopidogrel.
Methods:
Parallel MEA and LTA were performed at baseline and after 6 and 12 weeks in 31 patients treated with percutaneous coronary intervention after NSTEMI. Adenosine diphosphate (ADP) concentrations 2 μM, 6.5 μM and 10 μM were used. Parallel testings in both arterial and venous blood were performed at baseline. MEA and LTA cut-off levels were applied to discriminate aggregation values suggesting presence or absence of high platelet reactivity (HPR).
Results:
Arterial and venous MEA and LTA aggregation were similar. Within-subject variability in both MEA and LTA aggregation throughout the study was moderate. According to MEA, eight patients had HPR at baseline (MEA aggregation > 47 U). Defining > 47% as the LTA aggregation HPR cut-off level, the same number of patients (eight) had HPR according to LTA. Of the 93 MEA/LTA observations 81 (87.1%) gave the same HPR classification. MEA vs. LTA agreement at baseline was slightly inferior to that obtained after 12 weeks.
Conclusions:
MEA and LTA aggregation in arterial and venous blood seem similar. Within-subject variability over time was moderate, and the agreement between LTA and MEA was good, and stable in most patients.
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