Abstract
In the context of interventional cardiology, platelet function testing may identify patients treated with P2Y12-inhibitors at an increased risk of mortality, thrombosis and bleeding. Several whole blood point-of-care platelet function analyzers are available; however, inter-device differences have not been examined systematically. To compare three platelet function tests under standardized in vitro conditions. Healthy volunteer (n = 10) blood samples were spiked with increasing concentrations of ticagrelor (0–7500 ng/mL) and/or ASA (0–3280 ng/mL), measured on three platelet function analyzers (TEG®6s, Multiplate®, and VerifyNow®) and respective Effective Concentration (EC) levels EC10, EC50 and EC90 were calculated. Repeatability was assessed in a separate group of pooled blood samples (n = 10) spiked with ticagrelor at EC10, EC50 and EC90. ASA had no impact on ADP-activated channels for all three devices. TEG®6s was able to distinguish (p ≤ 0.05) between all ticagrelor EC zones; VerifyNow® and Multiplate® were able to distinguish between three and two zones, respectively. Multiplate® showed the largest window between EC10 and EC90 (19–9153 ng/mL), followed by TEG®6s (144–2589 ng/mL), and VerifyNow® (191–1100 ng/mL). Drug effect models distribution of disagreements were identified for TEG®6s (5.0%), VerifyNow® (8.3%), and Multiplate® (13.3%). TEG®6s showed the smallest average coefficient of variation between EC conditions (5.1%), followed by Multiplate® (14.1%), and VerifyNow® (17.7%). Linear models could be generated between TEG®6s and Multiplate®, but not VerifyNow®. Significant differences were found between whole blood point-of-care platelet function analyzers and the clinical impact of these differences needs to be further investigated.
Highlights
Dual antiplatelet therapy (DAPT) consisting of acetylsalicylic acid (ASA) and a P2Y12 receptor blocker is recommended to reduce platelet reactivity and prevent thrombotic events after percutaneous coronary intervention (PCI) [1]
According to current revascularization guidelines (Class IIb recommendation), platelet function testing may be considered to de-escalate DAPT in patients with acute coronary syndrome; in those deemed unsuitable for maintained potent platelet inhibition over 12 months [1, 5]
This study was conducted in two stages: the first study assessed the concentration dependent effects of ticagrelor and ASA on platelet function measurements obtained with the three analyzers (TEG®6s, Multiplate®, and VerifyNow®), while the second study evaluated the repeatability of measurement with each analyzer at fixed concentrations
Summary
Dual antiplatelet therapy (DAPT) consisting of acetylsalicylic acid (ASA) and a P2Y12 receptor blocker is recommended to reduce platelet reactivity and prevent thrombotic events after percutaneous coronary intervention (PCI) [1]. DAPT, is associated with increased risk of bleeding as compared with treatment with a single platelet inhibitor and further increased with the potency of the combination partner [2]. According to current revascularization guidelines (Class IIb recommendation), platelet function testing may be considered to de-escalate DAPT in patients with acute coronary syndrome; in those deemed unsuitable for maintained potent platelet inhibition over 12 months [1, 5]. Platelet function testing may be considered to guide the timing of cardiac surgery in patients who have recently received P2Y12 inhibitors [1, 6]
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