Association of Impedance Aggregometry-Measured Platelet Aggregation With Thromboembolic Events in Patients Who Undergo Carotid Endarterectomy: A Pilot Study

Abstract

ObjectivesThe aim of the current study was to assess the relationship between thrombin receptor activator peptide 6 (TRAP test), adenosine-5′-diphosphate (ADP test) and arachidonic acid (ASPI test) and stroke/TIA, using the multiple electrode aggregometry (Multiplate®) in patients undergoing CEA. DesignA retrospective study. SettingVascular surgery operating rooms of university hospital. ParticipantsOne hundred and thirty-one out of 474 patients undergoing CEA between November 2020 and October 2022. InterventionsNone. Measurements & Main ResultsA pre-operative blood sample of all enrolled patients was analyzed using the multiplate analyzer. Receiver operating characteristics curves were generated to test the ability of TRAP, ADP and ASPI in discriminating perioperative thromboembolic stroke/TIA. A logistic LASSO regression model was used to identify factors independently associated with stroke/TIA. Eight patients suffered of perioperative stroke/TIA. Although all the platelet functional assays showed an excellent predictive performance an ADP value exciding 72 U showed the highest specificity (87%) and sensitivity (68%) in discriminating patients who had perioperative thromboembolic stroke/TIA with a negative predictive value of 99% and a positive predictive value of 15%. After LASSO regression an ADP> 72 U and need of shunt during CEA were the only two variables independently associated with perioperative stroke/TIA. ConclusionSince the ADP test was independently associated with perioperative stroke/TIA, the assessment of platelet reactivity using Multiplate® may offer potential utility in monitoring patients undergoing CEA.