Variable responsiveness to clopidogrel and aspirin among patients with acute coronary syndrome as assessed by platelet function tests |
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| Authors: | Shenkman Boris Matetzky Shlomi Fefer Paul Hod Hanoch Einav Yulia Lubetsky Aharon Varon David Savion Naphtali |
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| Affiliation: | Amalia Biron Research Institute of Thrombosis and Hemostasis, Israel. |
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| Abstract: | ![]()
Unresponsiveness to clopidogrel or aspirin has been reported in patients with acute coronary syndrome (ACS). Platelet aggregometry (PA) and the Impact-R [Cone and Plate(let) Analyzer (CPA) technology, measuring whole blood platelet adhesion under flow conditions] were compared in detecting laboratory unresponsiveness to clopidogrel and aspirin among ACS patients. Platelet-rich plasma (PRP) samples were evaluated in 404 patients by PA using adenosine diphosphate (ADP) and arachidonic acid (AA) and whole blood samples by the Impact-R ADP- and AA-response tests. The first cohort (n=114) was assayed by PA on days 1 and 4 of the onset of ACS. A patient with relative decrease of /=70%. A patient with an absolute value of AA-induced maximal aggregation >/=60% was defined as laboratory NR patient to aspirin. The second cohort (n=290) was tested on day 4 by both systems and results analyzed by receiver operating characteristic curve. The following cut-off values of the Impact-R surface coverage were obtained:
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| Keywords: | ACS, acute coronary syndrome PA, platelet aggregometry CPA, Cone and Plate(let) Analyzer PRP, platelet-rich plasma ADP, adenosine diphosphate AA, arachidonic acid NR, non-responding ROC, receiver operating characteristic SC, surface coverage PCI, percutaneous coronary intervention VASP, vasodilator-stimulated phosphoprotein PPP, platelet-poor plasma PBS, phosphate-buffered saline AUC, area under the curve SD., standard deviation |
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