Application of platelet function testing to the bedside

Aspirin is effective for the prevention of cardiovascular events in patients with a history of vascular disease, as so-called secondary prevention. In general populations with no history of previous myocardial infarction or stroke, aspirin also seems useful for primary prevention of cardiovascular events, although the absolute benefits are smaller than those seen in patients with previous cardiovascular disease. Patients with diabetes mellitus are at an increased risk of cardiovascular events, but new trials have raised questions about the benefit of aspirin for primary prevention in patients with this disorder. This Review comprehensively examines the basic pharmacology of aspirin and provides an overview of the randomized, controlled trials of aspirin therapy that have included patients with diabetes mellitus. On the basis of currently available evidence from primary prevention trials, aspirin is estimated to reduce the relative risk of myocardial infarction and stroke by about 10% in patients with diabetes mellitus; however, aspirin also increases the risk of gastrointestinal bleeding. As such, low-dose aspirin therapy (75–162 mg) is reasonable for patients with diabetes mellitus and a 10-year risk of cardiovascular events >10%. Results from upcoming large trials will help clarify the effects of aspirin with greater precision, including whether the benefits differ between men and women.

show abstract

“…25 As surrogates for clinical endpoints, however, these methods are flawed for several reasons. 17,26 …”

Section: Aspirin Resistancementioning

confidence: 99%

Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Pignone

Williams

2010

Nat Rev Endocrinol

View full text Add to dashboard Cite

show abstract

“…As monitoring of hemostasis has become increasingly crucial for acute bed side decision making [53], e.g. to improve the treatment of women with postpartum hemorrhage [54], the modification of established assays used either in the laboratory or as a POCT, can help to reliably diagnose coagulation problems.…”

Section: Discussionmentioning

confidence: 99%

Closing the gap – detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry

et al. 2019

View full text Add to dashboard Cite

BackgroundHemorrhage and blood loss are still among the main causes of preventable death. Global hemostatic assays are useful point-of-care test (POCT) devices to rapidly detect cumulative effects of plasma factors and platelets on coagulation. Thromboelastography (TEG) and Thromboelastometry (ROTEM) are established methods in many anesthesiological departments for guided hemostatic treatment. However, von Willebrand disease remains undetected by standard ROTEM, especially during emergency care, despite being the most prevalent congenital hemostatic disorder.MethodsIn our monocentric cohort pilot study we focused on hemostatic challenges associated with von Willebrand disease. Twenty-seven patients with suspected von Willebrand disease were included. We modified the routine ROTEM assay by adding a preincubation with ristocetin and commercially available plasma-derived von Willebrand factor to identify clinically relevant von Willebrand disease (VWD).ResultsAddition of von Willebrand factor to the ristocetin assay of a VWD type 3 patient restored the reaction of the whole blood probe to match the response of a healthy person. Our modified ROTEM assay with ristocetin (Ricotem) showed that all high responders (n = 7) had VWD. In the low responder group (n = 16) – 10 of 16 had VWD and in the normal responder group (n = 5), 2 of 5 had mild type 1 VWD.ConclusionsThis new modification of the standard ROTEM assay enables the detection of otherwise unnoticed critical von Willebrand disease based on alterations in clot formation and might serve as a novel approach to reliably assess severe VWD patients by platelet-mediated blood clotting in an emergency setting. We recommend incorporating this new VWD-focused screening tool into the current ROTEM-based management algorithm of acute microvascular bleeding.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0672-8) contains supplementary material, which is available to authorized users.

show abstract

“…The most common platelet activation markers assessed by flow cytometry are P-selectin expression on the platelet surface (as a marker of α -granule secretion), the conformational change of GP IIb/IIIa into its active state (measured with monoclonal antibody PAC-1), platelet-leukocyte conjugates, microparticle examination, exposure of anionic, negatively charged phospholipids on the platelet surface (procoagulant activity), and phosphorylation of vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) (BioCytex, Marseille, France), as a marker of P2Y12 receptor activation-dependent signaling [18–20]. Many laboratories have measured a variety of different platelet activation markers and shown that they are elevated in various clinical conditions such as unstable angina, acute myocardial infarction, preeclampsia, peripheral vascular disease, and cerebrovascular ischemia.…”

Section: Platelet Function Testingmentioning

confidence: 99%

“…The growing clinical need coupled with the development of new, simpler POCT machines has resulted in a tendency of platelet function tests to be done away from specialized clinical hemostasis laboratories. This review focuses on the clinical utility of two representative instruments: impact cone and plate analyzer (DiaMed, Cressier, Switzerland) [2, 18, 19] and thrombelastography (TEG) (Hemoscope, Niles, IL, USA) [7–10, 21, 22] in more detail, and the others are referred to below in the section of monitoring antiplatelet therapy.…”

Section: Platelet Function Testingmentioning

confidence: 99%

See 1 more Smart Citation

Platelet Function Tests: A Review of Progresses in Clinical Application

Choi

Han

2014

BioMed Research International

View full text Add to dashboard Cite

The major goal of traditional platelet function tests has been to screen and diagnose patients who present with bleeding problems. However, as the central role of platelets implicated in the etiology of arterial thrombotic diseases such as myocardial infarction and stroke became widely known, platelet function tests are now being promoted to monitor the efficacy of antiplatelet drugs and also to potentially identify patients at increased risk of thrombosis. Beyond hemostasis and thrombosis, an increasing number of studies indicate that platelets play an integral role in intercellular communication, are mediators of inflammation, and have immunomodulatory activity. As new potential biomarkers and technologies arrive at the horizon, platelet functions testing appears to take on a new aspect. This review article discusses currently available clinical application of platelet function tests, placing emphasis on essential characteristics.

show abstract

Application of platelet function testing to the bedside

Abstract: SummaryThe ability to test platelet reactivity in clinical practice could help in making informed decisions on both initiation and titration of anti-platelet drug therapies. However, many barriers still remain to the effective implementation of such techniques.

Cited by 18 publications

References 53 publications

Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Closing the gap – detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry

Platelet Function Tests: A Review of Progresses in Clinical Application

Contact Info

Product

Resources

About