Related Experiment Video
Updated: May 1, 2026
Dynamic Multiparameter Platelet Function Assessment Using a Capacitive Biosensor
Published on: May 2, 2025
Point of care platelet activity measurement in primary PCI [PINPOINT-PPCI]: a protocol paper
Thomas W Johnson1, Debbie Marsden, Andrew Mumford
1Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK. Tom.Johnson@uhbristol.nhs.uk.
Insights
This study investigates platelet reactivity in ST-elevation myocardial infarction (STEMI) patients receiving bivalirudin and prasugrel during primary percutaneous coronary intervention (PCI). Understanding baseline reactivity is key to optimizing anti-thrombotic therapy and minimizing risks.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Optimal treatment for ST-elevation myocardial infarction (STEMI) requires rapid diagnosis and mechanical revascularization via percutaneous coronary intervention (PCI).
- Balancing anti-thrombotic therapy to prevent thrombosis while minimizing bleeding risk is crucial and treatment regimens are evolving.
- Potent, fast-acting anti-platelet therapies are needed for rapid reperfusion in STEMI, but their interaction with baseline platelet reactivity requires investigation.
Purpose of the Study:
- To describe the variation in platelet reactivity in acute STEMI patients treated with primary PCI, bivalirudin, and prasugrel.
- To assess the prevalence of high residual platelet reactivity within 24 hours of primary PCI.
- To investigate the association between platelet reactivity and door-to-procedure time.
Main Methods:
- Prospective observational study protocol.
- Multiplate platelet function analyzer used to measure platelet reactivity at presentation, end of PCI, and 1, 2, & 24 hours post-procedure.
- Target sample size of 108 participants at a single center.
Main Results:
- Baseline platelet reactivity in STEMI patients may influence the effectiveness of acute anti-thrombotic and anti-platelet therapies.
- This study will characterize platelet reactivity variations and the pharmacodynamic response to bivalirudin and prasugrel.
- Findings will generate hypotheses for future trials on STEMI pharmacotherapies.
Conclusions:
- Baseline platelet reactivity is a significant factor in STEMI treatment outcomes.
- The study assesses the pharmacodynamic effects of combined bivalirudin and prasugrel therapy.
- Results will inform future research into optimizing anti-thrombotic strategies for STEMI patients.
Background:
Optimal treatment of acute ST-elevation myocardial infarction (STEMI) involves rapid diagnosis, and transfer to a cardiac centre capable of percutaneous coronary intervention (PCI) for immediate mechanical revascularisation. Successful treatment requires rapid return of perfusion to the myocardium achieved by thromboaspiration, passivation of the culprit lesion with stent scaffolding and systemic inhibition of thrombosis and platelet activation. A delicate balance exists between thrombosis and bleeding and consequently anti-thrombotic and antiplatelet treatment regimens continue to evolve. The desire to achieve reperfusion as soon as possible, in the setting of high platelet reactivity, requires potent and fast-acting anti-thrombotic/anti-platelet therapies. The associated bleeding risk may be minimised by use of short-acting anti-thrombotic intravenous agents. However, effective oral platelet inhibition is required to prevent recurrent thrombosis. The interaction between baseline platelet reactivity, timing of revascularisation and effective inhibition of thrombosis is yet to be formally investigated.
Methods/Design:
We present a protocol for a prospective observational study in patients presenting with acute STEMI treated with primary PCI (PPCI) and receiving bolus/infusion bivalirudin and prasugrel therapy. The objective of this study is to describe variation in platelet reactivity, as measured by the multiplate platelet function analyser, at presentation, the end of the PPCI procedure and 1, 2, & 24 hours post-procedure. We intend to assess the prevalence of high residual platelet reactivity within 24 hours of PPCI in acute STEMI patients receiving prasugrel and bivalirudin. Additionally, we will investigate the association between high platelet reactivity before and after PPCI and the door-to-procedure completion time.This is a single centre study with a target sample size of 108 participants.
Discussion:
The baseline platelet reactivity on presentation with a STEMI may impact on the effect of acute anti-thrombotic and anti-platelet therapy and expose patients to a heightened risk of bleeding or ongoing thrombosis. This study will define the baseline variation in platelet reactivity in a population of patients experiencing acute STEMI and assess the pharmacodynamic response to combined treatment with bivalirudin and prasugrel. The data obtained from this trial will be hypothesis generating for future trials testing alternative pharmacotherapies in the acute phase of treatment for STEMI.
Trial Registration:
This study has approval from Wiltshire research ethics committee (10/H0106/87) and is registered with current controlled trials (http://www.controlled-trials.com/ISRCTN82257414).
