Evaluation of the Platelet Mapping™ Assay on rotational thromboelastometry ROTEM®

Abstract

Rotational thromboelastometry ROTEM is available as point-of-care coagulation monitoring in an increasing number of European operating theatres and emergency rooms. The Platelet Mapping Assay has been described as a platelet aggregation assay for thromboelastography TEG. The aim of this experimental trial was to evaluate feasibility of the Platelet Mapping Assay on the ROTEM test system. Whole blood was drawn from 22 adult volunteers and patients with and without antiplatelet medication. Platelet aggregability was determined in three whole blood assays: the Platelet Mapping Assay using both activators arachidonic acid (AA) and adenosine diphosphate (ADP) on TEG, its adapted version on ROTEM, and the multiple electrode impedance aggregometer Multiplate. Percent aggregation inhibition results were plotted in a linear regression analysis and correlation was estimated. Sensitivity and specificity for detecting antiplatelet medication were determined. Overall correlations were statistically significant with an r(2) = 0.83 in AA-activated and an r(2) = 0.82 in ADP-activated Platelet Mapping Assay. AA-activated tests and the Multiplate analysis identified aspirin-inhibition in 86% and 100%, respectively. ADP-activated tests and the Multiplate analysis identified clopidogrel-inhibition in 67% and 89%, respectively. Specificity was low both in ROTEM and TEG. Differences in frequency distribution between the results obtained in ROTEM and TEG were not statistically significant. The Platelet Mapping Assay can be performed on the ROTEM. For the perioperative scenario, however, longer test duration and higher costs have to be considered compared to Multiplate analyses.

Diagnostic Performance and Therapeutic Consequence of Thromboelastometry Activated by Kaolin versus a Panel of Specific Reagents

“…3,32 All assays were processed on the ROTEM equipment. We assumed there would be limited differences between applying ROTEM or TEG analyzers, as has been forwarded in recent studies, 43 but minor dissimilarities cannot be excluded. In the current study design, it was not possible to address clinical outcome parameters or aspects of health economics.…”

Application of thrombelastography/thromboelastometry to veterinary medicine

“…The primary uses to date for TEG PlateletMapping include monitoring platelet inhibition therapy and diagnosing naturally occurring thrombocytopathies; however, this novel technique may also be able to identify platelet hyperreactivity 105 . Recently, PlateletMapping was also validated for use in ROTEM analyzers 106 …”

Advances in the monitoring of anti-P2Y12therapy

“…Unlike platelet function tests, these instruments have been traditionally utilized within surgical and anesthesiology departments as POC tests for determining the risk of bleeding and as a guide to transfusion requirements [138,144]. Recent studies have shown the potential of TEG for monitoring clopidogrel [139,145,146].…”

“…With the PlateletMapping TM system, arachidonic acid and ADP can be used as agonists to pre-activate platelets within the TEG system, thus making the assay theoretically suitable to monitor antiplatelet drugs, although the test lacks sensitivity to detect moderate changes in platelet function [95,138,139]. TEG Õ /ROTEM tests are relatively rapid to perform (<30 min) and have traditionally been used as POC tests in surgical departments.…”