Head to Head Comparison of Two Point-of-care Platelet Function Tests Used for Assessment of On-clopidogrel Platelet Reactivity in Chinese Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention
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Published on: November 8, 2024
Yi Yao1, Jia-Hui Zhang1, Xiao-Fang Tang1
1Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
VerifyNow and TEG show moderate correlation for monitoring clopidogrel therapy in Chinese patients. VerifyNow is a potential alternative to TEG for assessing platelet reactivity post-PCI.
Area of Science:
- Cardiology
- Clinical Chemistry
- Pharmacology
Background:
- Platelet function tests guide personalized antiplatelet therapy.
- Thromboelastography (TEG) is clinically accepted in China, while VerifyNow is primarily for research.
- This study compares TEG and VerifyNow for evaluating on-clopidogrel platelet reactivity in Chinese patients.
Purpose of the Study:
- Compare two point-of-care platelet function tests: TEG and VerifyNow.
- Analyze the consistency between TEG and VerifyNow in evaluating on-clopidogrel platelet reactivity.
- Assess the utility of VerifyNow as an alternative to TEG in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- 184 Chinese patients undergoing PCI were enrolled.
- On-clopidogrel platelet reactivity was assessed 3 days post-PCI using TEG and VerifyNow with adenosine diphosphate.
- High on-clopidogrel platelet reactivity (HPR) and low on-clopidogrel platelet reactivity (LPR) were defined based on inhibition of platelet aggregation (IPA) for TEG and P2Y12 reaction unit (PRU) for VerifyNow.
Main Results:
- VerifyNow and TEG demonstrated a moderate, significant correlation (r = -0.511) in assessing platelet reactivity.
- Agreement in identifying HPR between TEG and VerifyNow was poor (κ = 0.225), while agreement for LPR was moderate (κ = 0.412).
- Using TEG as reference, optimal VerifyNow cutoff values for Chinese patients were identified as PRU >205 for HPR and PRU <169 for LPR.
Conclusions:
- VerifyNow shows moderate correlation with TEG in assessing on-clopidogrel platelet reactivity.
- VerifyNow demonstrates potential as a viable alternative to TEG for monitoring clopidogrel therapy in Chinese patients.
- Further validation of VerifyNow's clinical utility in this population is warranted.
Background:
Platelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy. In China, the thromboelastography (TEG) test has been well accepted in clinics, whereas VerifyNow, mainly used for scientific research, has not been used in routine clinical practice. The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).
Methods:
A total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study. On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist. Based on the previous reports, an inhibition of platelet aggregation (IPA) <30% for TEG or a P2Y12 reaction unit (PRU) >230 for VerifyNow was defined as high on-clopidogrel platelet reactivity (HPR). An IPA >70% or a PRU <178 was defined as low on-clopidogrel platelet reactivity (LPR). Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient (r) and kappa value (κ), respectively.
Results:
Our results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity (r = -0.511). A significant although poor agreement (κ = 0.225) in identifying HPR and a significantly moderate agreement in identifying LPR (κ = 0.412) were observed between TEG and VerifyNow. By using TEG as the reference for comparison, the cutoff values of VerifyNow for the Chinese patients in this study were identified as PRU >205 for HPR and PRU <169 for LPR.
Conclusions:
By comparing VerifyNow to TEG which has been widely used in clinics, VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.
