Discordance Between VASP Phosphorylation and Platelet Aggregation in Defining High On-Clopidogrel Platelet Reactivity...

Area of Science:

• Cardiology
• Pharmacology
• Biomedical Engineering

Background:

• High on-clopidogrel platelet reactivity (HPR) is linked to adverse outcomes after ST-elevation myocardial infarction (STEMI).
• Assessing platelet reactivity is crucial for tailoring antiplatelet therapy.
• Discordance exists between different assays for measuring platelet function.

Purpose of the Study:

• To identify clinical factors associated with discordance between vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) flow cytometry (FCM) and light transmission aggregometry (LTA) in defining HPR post-STEMI.
• To understand how these measurement differences impact clinical decisions.

Main Methods:

• Simultaneous measurement of platelet responsiveness using VASP-P FCM and LTA in 90 STEMI patients post-primary percutaneous coronary intervention.
• Measurements were taken on day 1 and day 6 post-STEMI onset.
• Multiple variable-adjusted logistic regression analysis was employed to identify predictors of discordance.

Main Results:

• Both VASP-P FCM and LTA showed reduced platelet reactivity on day 6 after dual antiplatelet therapy.
• Smoking (OR: 4.507) and longer onset-to-admission time (OR: 1.196 per hour) were independent predictors of discordance between the two methods.
• Improved correlation and concordance were observed in nonsmokers compared to smokers.

Conclusions:

• Smoking and prolonged onset-to-admission time are significant factors contributing to discordance in HPR assessment between VASP-P FCM and LTA.
• These factors should be considered when personalizing antiplatelet therapy strategies in STEMI patients.