Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

Godino, Cosmo; Mendolicchio, Loredana; Figini, Filippo; Latib, Azeem; Sharp, Andrew; Cosgrave, John; Calori, Giliola; Cera, Michela; Chieffo, Alaide; Castelli, Alberto; Maseri, Attilio; Ruggeri, Zaverio M.; Colombo, Antonio

doi:10.1186/1477-9560-7-4

Cited by 46 publications

(28 citation statements)

References 27 publications

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“…This value indicates the level of active clopidogrel metabolite-P2Y12 receptor interaction, which inhibits platelet aggregation. 18 According to the manufacturer's manual, percentage inhibition is derived by the VerifyNow P2Y12 assay from the platelet reactivity unit (PRU) and baseline platelet thrombosis activity (BASE). The formula used to calculate percentage inhibition is Percentage Inhibition ϭ (BASE Ϫ PRU) ϫ 100/BASE.…”

Section: Ex Vivo Clopidogrel Response Testingmentioning

confidence: 99%

Association betweenCYP2C19Polymorphisms and Outcomes in Cerebral Endovascular Therapy

Lin¹,

Todaro

Chan

et al. 2015

AJNR Am J Neuroradiol

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Section: Ex Vivo Clopidogrel Response Testingmentioning

confidence: 99%

Association betweenCYP2C19Polymorphisms and Outcomes in Cerebral Endovascular Therapy

Lin¹,

Todaro

Chan

et al. 2015

AJNR Am J Neuroradiol

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“…Recently, easier and more accurate assays such as the VerifyNow® P2Y12 assay have become standard in many hospital settings, as in ours [45][46][47]. This test prevents nonspecific activation of platelets and corrects for baseline platelet activity, making this test more specific for the inhibition from clopidogrel [48]. The VerifyNow® P2Y12 correlates well with levels of clopidogrel in the plasma and has thus been reported as one of the most accurate assays of platelet activity in response to the drug [45].…”

Section: Discussionmentioning

confidence: 99%

Utility of Antiplatelet Therapy With Ticlopidine in Patients Refractory to Clopidogrel for Intracranial Stenting: A Single Institution Experience

Shukla

2012

J Neurol Res

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Background: The use of antiplatelets in intra-arterial stenting for cerebrovascular disease has been associated with a decrease in morbidity and mortality. Ticlopidine, a thienopyridine that inhibits ADP-mediated platelet aggregation, has been used with aspirin to treat patients with stroke and prevent thromboembolic occlusion in patients who have undergone endovascular procedures. Because of the reported side effects associated with ticlopidine such as bleeding, thrombocytopenic thrombotic purpura and neutropenia, another thienopyridine, clopidogrel, became the agent of choice as an antiplatelet regimen. However, as the literature accumulates, it is becoming evident that many patients are resistant or allergic to clopidogrel, thus highlighting the need for an alternative antiplatelet agent to prevent complications associated with endovascular management.

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“…Shim et al reported that the rate of clopidogrel resistance (defined as a percent inhibition <20%) was 40%. 28 Godino et al reported that the rate of clopidogrel resistance defined as a % inhibition of ≤15% was 21% 34 . The wide variation is also partly because of the difference between investigators' options regarding the cut-off value which should be considered as suboptimal and also because of the different time interval taken between drug intake and measurement of blood samples.…”

Section: Discussionmentioning

confidence: 99%

Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention

et al. 2014

Bangladesh Med Res Counc Bull

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Dual antiplatelet treatment (DAPT) with aspirin and clopidogrel is vital after percutaneous coronary intervention (PCI). Clopidogrel and prasugrel act on P2Y12 platelet surface receptors. Both these P2Y12 inhibitors are pro-drugs and depend on cytochrome system of the liver for their conversion to active metabolite. There is growing concern regarding suboptimal response in platelet inhibition by clopidogrel. Verify Now system got approval by Federal Drug Administration, USA, for assessing platelet function as its result is almost comparable to gold standard Light Transmission Aggregometry (LTA). There are no data on the prevalence of clopidogrel resistance in Bangladeshi population. Prasugrel, as an antiplatelet drug, is a newer introduction in this country. This study will show light on the efficacy of these drugs on our population especially in patients who undergo PCI where DAPT is mandatory. A total 120 (60 diabetics ) patients with Acute Coronary Syndrome (ACS), were alternatively given 600 mg clopidogrel loading dose (LD) followed by 75 mg maintenance dose (MD) daily or 60 mg LD of prasugrel followed by 10 mg MD daily. Five samples of blood were taken at different time intervals over a period of 2 weeks. Measurement of percent inhibition of P2Y12 was done by VerifyNow. Patients who showed less than 20% inhibition (clopidogrel resistant) at any stage were switched to prasugrel. The outcomes of clopidogrel, prasugrel and clopidogrel switched to prasugrel groups were then compared. Nearly half (46.7%) of the patients in the clopidogrel group was found resistant to the drug as opposed to none in the prasugrel group. No difference was found between diabetic and non-diabetic subjects with respect to drug resistance. Intracoronary blood samples showed high degree of platelet inhibition with prasugrel. There was a gradual decline of platelet inhibition over two weeks with prasugrel. Almost fifty percent of the population is clopidogrel resistant in our study. Prasugrel is a much more potent antiplatelet drug and should be preferred in patients undergoing PCI. Prasugrel may also show resistance over time.

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Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

Cited by 46 publications

References 27 publications

Association betweenCYP2C19Polymorphisms and Outcomes in Cerebral Endovascular Therapy

Association betweenCYP2C19Polymorphisms and Outcomes in Cerebral Endovascular Therapy

Utility of Antiplatelet Therapy With Ticlopidine in Patients Refractory to Clopidogrel for Intracranial Stenting: A Single Institution Experience

Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention

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