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Updated: Nov 21, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet-fibrin clot strength measured by thromboelastography could predict hypercoagulability and antiplatelet
Xiao-Qin Yan1, Chi Zhang2, Hong-Yao Shi3
1School of Pharmacy, Nantong University, Nantong, China; Department of Pharmacy, Shanghai Pudong Hospital, Shanghai, China; Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Clopidogrel therapy shows varied effectiveness in patients after percutaneous coronary intervention (PCI). Personalized antiplatelet strategies are needed to improve outcomes for acute coronary syndrome (ACS) patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- A significant portion of patients undergoing percutaneous coronary intervention (PCI) and treated with clopidogrel experience recurrent thrombotic events.
- This highlights the limitations of a one-size-fits-all approach to antiplatelet therapy.
Purpose of the Study:
- To evaluate the variability in platelet function and hypercoagulability among patients with coronary artery disease (CAD) and healthy individuals after PCI.
- To assess the effectiveness of standard dual antiplatelet therapy (DAPT) with aspirin and clopidogrel.
Main Methods:
- Retrospective enrollment of 571 patients (ACS, old myocardial infarction, non-CAD) from July 2017 to April 2019.
- Standard DAPT (aspirin 100 mg, clopidogrel 75 mg) was administered to CAD patients post-PCI.
- Platelet function was assessed using thrombelastography (TEG) by measuring thrombin-induced (MAthrombin) and ADP-induced (MAADP) platelet-fibrin clot strength.
Main Results:
- STEMI patients exhibited the highest MAthrombin, while non-CAD patients had the lowest.
- Higher MAADP levels were observed in STEMI and NSTEMI patients compared to UA patients.
- Significant variations in MAADP levels were found across ACS subtypes, with a substantial percentage of UA patients showing low platelet inhibition (MAADP <31 mm).
Conclusions:
- There are considerable variations in hypercoagulability and clopidogrel's antiplatelet effects among OMI and ACS patients post-PCI.
- Personalized antiplatelet therapy, tailored to individual responses to P2Y12 inhibitors, is crucial for optimizing patient outcomes.
Background:
It has been estimated that nearly one-fifth post-percutaneous coronary intervention (PCI) patients treated with clopidogrel continued to have recurrent thrombotic events, which implied the limitation of "one-size-fits all" strategy for antiplatelet therapy.
Methods:
From July 2017 to April 2019, patients with acute coronary syndrome [ACS, including unstable angina (UA), non-ST segment elevation myocardial infraction (NSTEMI), and ST segment elevation myocardial infraction (STEMI)] or old myocardial infarction (OMI), or patients without coronary heart disease (non-CAD) were retrospectively enrolled in this study. For CAD patients undergoing PCI, standard dual antiplatelet therapy (100 mg aspirin and 75 mg clopidogrel) was prescribed. After administration of dual antiplatelet agents for at least 5 days, whole blood samples were collected and platelet function was tested using thrombelastography (TEG). Thrombin-induced platelet-fibrin clot strength (MAthrombin) and ADPinduced platelet-fibrin clot strength (MAADP) were measured to assess the hypercoagulability and antiplatelet effects.
Results:
A total of 571 patients, including 479 ACS patients, 21 OMI patients and 71 non-CAD patients were enrolled. Highest level of MAthrombin was detected in STEMI patients, while lowest MAthrombin level was observed in non-CAD patients (P1 <0.05 for OMI vs. non-CAD; P2 <0.001 for ACS vs. non-CAD; P3<0.05 among ACS). Higher MAADP was also observed in STEMI and NSTEMI patients compared with UA patients (P<0.001). When MAADP was divided into trisections (MAADP <31; 31-47; >47 mm), a considerable portion of 41.8% ACS patients were in the first trisection (MAADP <31 mm), containing 50.4% of UA patients, 35.7% of NSTEMI patients and 26.5% of STEMI patients, with significant difference being observed between UA patients and other ACS patients (P<0.05 for NSTEMI vs. UA; P<0.001 for STEMI vs. UA). Meanwhile, 27.6% of NSTEMI and 31.0% of STEMI patients were in the third trisection (MAADP >47 mm), which was significantly higher than that of UA patients (12.7%) (P<0.001 for NSTEMI or STEMI vs. UA).
Conclusions:
Considering various degrees of hypercoagulability and antiplatelet effects of clopidogrel among OMI and ACS patients post-PCI. More attention should be paid to personalized antiplatelet therapy according to individual's effects of P2Y12 receptor inhibitors.
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