TY - JOUR
T1 - Role of the laboratory in monitoring patients receiving dual antiplatelet therapy
AU - Vidali, M.
AU - Rolla, R.
AU - Parrella, M.
AU - Cassani, C.
AU - Manzini, M.
AU - Portalupi, M. R.
AU - Serino, R.
AU - Prando, M. D.
AU - Bellomo, G.
AU - Pergolini, P.
PY - 2012/10
Y1 - 2012/10
N2 - Introduction: The increasing demand for therapeutic monitoring in patients receiving antiplatelet therapy has been paralleled by the development of instruments and tests whose clinical usefulness is still under debate. We devised a laboratory approach to detect patients with antiplatelet resistance at risk to develop thrombotic events. Methods: One hundred and eighty patients, under aspirin and clopidogrel after angioplasty and stent implantation, were studied by PFA100® with collagen/epinephrine (CoEPI, cutoff 165s) cartridge and by Multiplate® using arachidonic acid (ASPItest, pos<862AUC), ADP (ADPtest, pos<417AUC), and collagen (COLtest, pos<607AUC). Results: Only 67 of 173 patients with ASPI<862 displayed a prolonged CoEPI and up to 65 patients had normal CoEPI despite ASPI<300. Patients with ASPI<300 had significantly lower COL than patients with ASPI>300. One hundred and thirty-eight patients displaying ADP<417 had significantly lower COL than those with ADP>417. Association between COL and ADP remained after ASPI stratification: in patients with suboptimal (ASPI 300-892) or maximal (ASPI<300) response to aspirin, having ADP<417 (clopidogrel responsive) increased COL positivity, respectively, from 9.5 to 58.8% and from 47.6 to 82.7%. Conclusion: A combination of specific tests may be useful in identifying higher-risk patients with poor compliance or drug resistance who potentially may benefit from therapy change.
AB - Introduction: The increasing demand for therapeutic monitoring in patients receiving antiplatelet therapy has been paralleled by the development of instruments and tests whose clinical usefulness is still under debate. We devised a laboratory approach to detect patients with antiplatelet resistance at risk to develop thrombotic events. Methods: One hundred and eighty patients, under aspirin and clopidogrel after angioplasty and stent implantation, were studied by PFA100® with collagen/epinephrine (CoEPI, cutoff 165s) cartridge and by Multiplate® using arachidonic acid (ASPItest, pos<862AUC), ADP (ADPtest, pos<417AUC), and collagen (COLtest, pos<607AUC). Results: Only 67 of 173 patients with ASPI<862 displayed a prolonged CoEPI and up to 65 patients had normal CoEPI despite ASPI<300. Patients with ASPI<300 had significantly lower COL than patients with ASPI>300. One hundred and thirty-eight patients displaying ADP<417 had significantly lower COL than those with ADP>417. Association between COL and ADP remained after ASPI stratification: in patients with suboptimal (ASPI 300-892) or maximal (ASPI<300) response to aspirin, having ADP<417 (clopidogrel responsive) increased COL positivity, respectively, from 9.5 to 58.8% and from 47.6 to 82.7%. Conclusion: A combination of specific tests may be useful in identifying higher-risk patients with poor compliance or drug resistance who potentially may benefit from therapy change.
KW - Aspirin
KW - Clopidogrel
KW - Dual antiplatelet therapy
KW - Laboratory monitoring
KW - Multiplate
UR - http://www.scopus.com/inward/record.url?scp=84865570822&partnerID=8YFLogxK
U2 - 10.1111/j.1751-553X.2012.01428.x
DO - 10.1111/j.1751-553X.2012.01428.x
M3 - Article
SN - 1751-5521
VL - 34
SP - 484
EP - 494
JO - International Journal of Laboratory Hematology
JF - International Journal of Laboratory Hematology
IS - 5
ER -