Comparison of acetylsalicylic acid and clopidogrel non-responsiveness assessed by light transmittance aggregometry and PFA-100^® in patients undergoing neuroendovascular procedures

Abstract

ObjectivesDual platelet inhibition is commonly used for prevention of cardiovascular events in patients undergoing neuroendovascular procedures. Non-responsiveness to platelet inhibitors may be associated with adverse outcomes. The aim of this study was to evaluate the reliability of the platelet function analyzer PFA-100® in comparison to light transmittance aggregometry (LTA) for monitoring clopidogrel and acetylsalicylic acid (ASA) non-responsiveness in a cohort of patients treated for intracranial aneurysm or cranial artery stenosis.MethodsNon-responsiveness to clopidogrel and ASA was assessed by LTA using adenosine diphosphate (ADP) and arachidonic acid and by PFA-100® with the ADP/prostaglandin E1 (PGE1) and collagen/epinephrine cartridges, respectively.ResultsA total of 203 patients (145 females; median age, 57 years) were analyzed. Agreement between the two tests was poor for clopidogrel non-responsiveness (ƙ=0.19) and not better than chance for ASA non-responsiveness (ƙ=0.01). Clopidogrel non-responsiveness by LTA and PFA-100® was associated with higher von Willebrand factor antigen and activity levels. ADP-induced platelet disaggregation was lower in patients with clopidogrel non-responsiveness as assessed by PFA-100®. Clopidogrel non-responsiveness by LTA was associated with a higher prevalence of diabetes and a higher body mass index (BMI). Adverse outcomes (death, thromboembolism, or in-stent thrombosis) occurred in 13% (n=26) of all patients independently of ASA and clopidogrel non-responsiveness as assessed by both devices.ConclusionsOur results show that LTA and PFA-100® are not interchangeable in the assessment of ASA and clopidogrel non-responsiveness in patients undergoing neuroendovascular interventions.

Personalized Dual Antiplatelet Therapy in Acute Coronary Syndromes: Striking a Balance Between Bleeding and Thrombosis

“…In a meta-analysis of 42 studies, Hovens et al reported a weighted mean prevalence of laboratory-defined aspirin resistance of 24% (range = 0–57%) with an inter-study heterogeneity ( I 2 ) of 94% [ 85 ]. Most included studies used one of three PFTs to define aspirin non-response, the choice of which strongly influenced estimates, consistent with studies that have demonstrated poor agreement between PFTs [ 87 , 88 ]. While this limits the practical applications of PFTs, they still provide reasonable evidence for aspirin resistance.…”

Harmonizing platelet function analyzer testing and reporting in a large laboratory network

“…For comparison, some CT NRRs reported in the contemporary 6,16–29 and original literature 30–53 are shown in Figure 3. In most instances, these NRRs differ from each other and also from the manufacturer ranges, especially for C/ADP.…”

“…The Siemens product information CT NRRs are shown by the green horizontal dashed lines. Figure A shows NRRs from some contemporary literature as obtained from the recent literature search (see Methods), and reflecting information from the past 3 years 6,16–29 . Figure B shows NRRs from some early literature as otherwise reviewed in Reference 10 30–53 .…”

“…As an example, the ICPMR laboratory recently , and reflecting information from the past 3 years. 6,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] Figure B shows NRRs from some early literature as otherwise reviewed in Reference 10. Reference numbers identify their place in the reference list.…”