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Predictive Value of Methods Measuring Platelet Activation for Ischemic Events in Patients Receiving Clopidogrel: A

Zhe Wang1,2, Qiufen Xie1, Qian Xiang1

  • 1Department of Pharmacy, Peking University First Hospital, Beijing, China.

Current Pharmaceutical Design
|February 8, 2019
PubMed

Insights

Light-transmission aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP), and VerifyNow effectively predict ischemic events in patients after percutaneous coronary intervention (PCI). These platelet function tests show considerable efficiency, with specific cut-off values recommended for clinical use.

Area of Science:

  • Cardiology
  • Clinical Chemistry
  • Medical Diagnostics

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
  • Monitoring platelet function is crucial to prevent ischemic events in patients undergoing PCI, especially those treated with antiplatelet agents like clopidogrel.
  • Various methods exist to assess platelet reactivity, including light-transmission aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP) phosphorylation assays, and point-of-care devices like VerifyNow.

Purpose of the Study:

  • To investigate and compare the efficiency and predictive value of LTA, VASP, and VerifyNow in identifying ischemic events in patients post-PCI.
  • To analyze the sensitivity and specificity of these tests in predicting various clinical outcomes.
  • To determine optimal cut-off values for each assay to predict ischemia.

Main Methods:

  • A systematic review and meta-analysis of 31 studies involving 17,314 participants.
  • Inclusion of studies utilizing LTA, VASP, or VerifyNow to predict ischemic events.
  • Analysis of study quality and efficiency using Review Manager 5.3, calculating sensitivity, specificity, and summary ROC (sROC) curves.

Main Results:

  • LTA, VASP, and VerifyNow demonstrated considerable efficiency in predicting ischemic clinical events.
  • Subgroup analyses revealed varying sensitivities and specificities for predicting outcomes like cardiac death, myocardial infarction, and stent thrombosis.
  • VerifyNow showed no statistically significant higher AUC of sROC compared to LTA and VASP for predicting ischemic events in clopidogrel-treated patients; suggested cut-off values are LTA: 56%, VASP: 50%, VerifyNow: 235.

Conclusions:

  • LTA, VASP, and VerifyNow are valuable tools for predicting ischemic events in patients undergoing PCI.
  • The predictive performance varies based on the specific outcome and time frame; LTA showed better prediction for outcomes >6 months, while VerifyNow was better within 6 months.
  • The study provides recommended cut-off values to aid in the clinical interpretation of these platelet function tests.

Keywords:
LTAPCIROCVASPVerifyNowischemic events.

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