Assessment of platelet aggregation in clinical practice
Journal Title: Postępy Nauk Medycznych - Year 2014, Vol 27, Issue 2
Abstract
Introduction. Platelet mediated thrombosis plays central role in pathogenesis of acute coronary syndromes (ACS). Employing the point-of-care (POC) VerifyNow assay allows for bedside monitoring of platelet aggregation in patients treated with acetylsalicylic acid (ASA), P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor), and GPIIb/IIIa inhibitors (abciximab, triofiban, eptifibatide).Aim. To evaluate usefulness of point-of-care VerifyNow platelet aggregation tests in clinical practice.Material and methods. An analysis of platelet aggregation tests collected in a registry recording all VerifyNow assays performed at the Department of Cardiology, Postgraduate Medical School from 2010 to 2013 was completed. Patients (n = 38) were included in the study and a total of 56 tests (P2Y12, ASA, GPIIb/IIIa inhibitors) were carried out.Results. VerifyNow P2Y12 test was the most commonly performed assay (40 tests). Stent thrombosis was the main reason of assessment (18 patients). Assays were also performed in cases of patients with malabsorption syndromes, abnormalities in drug distribution (i.e. class III obesity, short bowel syndrome), with elevated cardiovascular risk (advanced atherosclerosis, multiple PCI, recurrent ACS), at high risk of bleeding complications, treated with unusual doses or routes of administration of antiplatelet agents, and with allergic reactions to clopidogrel.A poor response to clopidogrel therapy was observed in 20 (71%) of patients, with therapy modification in 15 (42%) cases. An increase in the dosage or a switch to a stronger antiplatet agent was performed in 8 (22%) patients, a lower dose was administered in 7 (19.4%) cases. New, more effective antiplatelet drugs were prescribed only to 2 (10%) patients.Conclusions. The VerifyNow assay is a simple and repetitive method of assessment of platelet aggregation. Employing the VerifyNow device in clinical practice allows to estimate effectively and accordingly modify antiplatelet therapy in selected group of patients, which in turn may lead to a reduction in the risk of bleeding as well as thrombotic complications.
Authors and Affiliations
Bogumił Ramotowski, Andrzej Budaj
Keywords
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