The risk of false results in the assessment of platelet function in the absence of antiplatelet medication: Comparision of the PFA-100, multiplate electrical impedance aggregometry and verify now assays

Can, Mehmet Mustafa; Tanboğa, İbrahi̇m Hali̇l; Türkyılmaz, Erdem; Karabay, Can Yücel; Akgün, Taylan; Koca, Fatih; Tokgoz, Hacer Ceren; Keleş, Nurşen; Özkan, Adem; Bezgin, Tahir; Özveren, Olcay; Sönmez, Kenan; Sağlam, Mustafa; Özdemir, Nihal; Kaymaz, Ci̇hangi̇r

doi:10.1016/j.thromres.2009.11.005

Cited by 28 publications

(16 citation statements)

References 30 publications

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“…There is as yet no formal definition of aspirin resistance, or any literature on its prevalence in stroke/TIA patients using the Multiplate device . Our results defined Aspirin resistance within our cohort as a mean aggregation of ≥23.08% with AA and a mean aggregation of ≥80.76% with ADP.…”

Section: Discussionmentioning

confidence: 69%

The clinical utility of Multiplate analyser measurement in platelet function testing following stroke and transient ischaemic attack

Mannu

Macartney

Lambert³

et al. 2014

European J of Haematology

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Section: Discussionmentioning

confidence: 69%

The clinical utility of Multiplate analyser measurement in platelet function testing following stroke and transient ischaemic attack

Mannu

Macartney

Lambert³

et al. 2014

European J of Haematology

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“…First, while impairment of platelet response to ADP and AA have been characterized in response to clopidogrel and aspirin, respectively, 16 there is no a priori sense of which agonists are relevant in the setting of trauma. Given the wide availability of over-the-counter medications with antiplatelet effects and the known variability of platelet function in the population at large, 17 one could posit that the dysfunction of AA and collagen pathways seen here may be the result of an occult medication-related effect, as opposed to a trauma-related phenomenon. However, the observed hyporesponsiveness to TRAP argues that this platelet dysfunction is related to injury, as neither thrombin generation nor platelet activation downstream of thrombin receptors are affected by COX-pathway blockade.…”

Section: Discussionmentioning

confidence: 99%

Characterization of platelet dysfunction after trauma

Kutcher

Redick

McCreery

et al. 2012

Journal of Trauma and Acute Care Surgery

335

325

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Background The increased morbidity and mortality associated with coagulopathy and thrombocytopenia after trauma are well-described. However, few studies have assessed platelet function after injury. Methods Blood samples were prospectively collected from 101 critically-injured trauma patients on arrival to the emergency department and serially after admission to a Level I urban trauma ICU from November 2010 to October 2011, and functionally assayed for responsiveness to adenosine diphosphate, thrombin receptor-activating peptide (TRAP), arachidonic acid (AA), and collagen using multiple electrode impedance aggregometry. Results Of 101 enrolled patients, 46 (45.5%) had below-normal platelet response to at least one agonist (‘platelet hypofunction’) on admission, and 92 patients (91.1%) had platelet hypofunction at some time during their ICU stay. Admission platelet hypofunction was associated with low Glasgow coma score (GCS) and a nearly 10-fold higher early mortality. Logistic regression identified admission GCS (odds ratio 0.819, p=0.008) and base deficit (odds ratio 0.872, p=0.033) as independent predictors of platelet hypofunction. Admission AA and collagen responsiveness were significantly lower in patients who died (p<0.01), while admission platelet counts were similar (p=0.278); Cox regression confirmed TRAP, AA, and collagen responsiveness as independent predictors of in-hospital mortality (p<0.05). Receiver operator characteristic analysis identified admission AA and collagen responsiveness as negative predictors of both 24-hour (AA AUC: 0.874, collagen AUC: 0.904) and in-hospital mortality (AA AUC: 0.769, collagen AUC: 0.717). Conclusions In this prognostic study, we identify clinically significant platelet dysfunction after trauma in the presence of an otherwise reassuring platelet count and standard clotting studies, with profound implications for mortality. Multiple electrode impedance aggregometry reliably identifies this dysfunction in injured patients, and admission arachidonic acid and collagen responsiveness are sensitive and specific independent predictors of both early and late mortality. Level of evidence Level I

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“…The predictive value of novel impedance platelet aggregometry in trauma and surgical bleeding still needs to be determined. 93 …”

Section: 35mentioning

confidence: 99%

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

et al. 2010

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Fluid resuscitation after massive hemorrhage in major surgery and trauma may result in extensive hemodilution and coagulopathy, which is of a multifactorial nature. Although coagulopathy is often perceived as hemorrhagic, extensive hemodilution affects procoagulants as well as anticoagulant, profibrinolytic, and antifibrinolytic elements, leading to a complex coagulation disorder. Reduced thrombin activation is partially compensated by lower inhibitory activities of antithrombin and other protease inhibitors, whereas plasma fibrinogen is rapidly decreased proportional to the extent of hemodilution. Adequate fibrinogen levels are essential in managing dilutional coagulopathy. After extensive hemodilution, fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased.Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies. Purified factor concentrates of plasma origin and from recombinant synthesis are increasingly used for a rapid restoration of targeted factors. Future clinical studies are necessary to establish the specific indication, dosing, and safety of novel hemostatic interventions.

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The risk of false results in the assessment of platelet function in the absence of antiplatelet medication: Comparision of the PFA-100, multiplate electrical impedance aggregometry and verify now assays

Cited by 28 publications

References 30 publications

The clinical utility of Multiplate analyser measurement in platelet function testing following stroke and transient ischaemic attack

The clinical utility of Multiplate analyser measurement in platelet function testing following stroke and transient ischaemic attack

Characterization of platelet dysfunction after trauma

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

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