Nakahara Hirotomo, Sarker Tania, Dean Christina L, Skukalek Susana L, Sniecinski Roman M, Cawley C Michael, Guarner Jeannette, Duncan Alexander, Maier Cheryl L
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States.
Front Cardiovasc Med. 2022 Jul 1;9:899594. doi: 10.3389/fcvm.2022.899594. eCollection 2022.
Platelet function testing to monitor antiplatelet therapy is important for reducing thromboembolic complications, yet variability across testing methods remains challenging. Here we evaluated the agreement of four different testing platforms used to monitor antiplatelet effects of aspirin (ASA) or P2Y inhibitors (P2Y12-I).
Blood and urine specimens from 20 patients receiving dual antiplatelet therapy were analyzed by light transmission aggregometry (LTA), whole blood aggregometry (WBA), VerifyNow PRUTest and AspirinWorks. Result interpretation based on pre-defined cutoff values was used to calculate raw agreement indices, and Pearson's correlation coefficient determined using individual units of measure.
Agreement between LTA and WBA for P2Y12-I-response was 60% ( = 0.65, high-dose ADP; = 0.75, low-dose ADP). VerifyNow agreed with LTA in 75% ( = 0.86, high-dose ADP; = 0.75, low-dose ADP) and WBA in 55% ( = 0.57) of cases. Agreement between LTA and WBA for ASA-response was 45% ( = 0.09, high-dose collagen WBA; = 0.19, low-dose collagen WBA). AspirinWorks agreed with LTA in 60% ( = 0.32) and WBA in 35% ( = 0.02, high-dose collagen WBA; = 0.08, low-dose collagen WBA) of cases.
Overall agreement varied from 35 to 75%. LTA and VerifyNow demonstrated the highest agreement for P2Y12-I-response, followed by moderate agreement between LTA and WBA. LTA and AspirinWorks showed moderate agreement for aspirin response, while WBA showed the weakest agreement with both LTA and AspirinWorks. The results from this study support the continued use of LTA for monitoring dual antiplatelet therapy, with VerifyNow as an appropriate alternative for P2Y12-I-response. Integration of results obtained from these varied testing platforms with patient outcomes remains paramount for future studies.
血小板功能检测对于监测抗血小板治疗、减少血栓栓塞并发症至关重要，但不同检测方法之间的差异仍然是一个挑战。在此，我们评估了用于监测阿司匹林（ASA）或P2Y抑制剂（P2Y12-I）抗血小板作用的四种不同检测平台的一致性。
对20例接受双联抗血小板治疗患者的血液和尿液样本进行光透射聚集法（LTA）、全血聚集法（WBA）、VerifyNow PRUTest和AspirinWorks检测。根据预先定义的临界值进行结果解读，以计算原始一致性指数，并使用个体测量单位确定Pearson相关系数。
LTA与WBA在P2Y12-I反应方面的一致性为60%（高剂量ADP时，κ = 0.65；低剂量ADP时，κ = 0.75）。VerifyNow与LTA在75%的病例中结果一致（高剂量ADP时，κ = 0.86；低剂量ADP时，κ = 0.75），与WBA在55%的病例中结果一致（κ = 0.57）。LTA与WBA在ASA反应方面的一致性为45%（高剂量胶原WBA时，κ = 0.09；低剂量胶原WBA时，κ = 0.19）。AspirinWorks与LTA在60%的病例中结果一致（κ = 0.32），与WBA在35%的病例中结果一致（高剂量胶原WBA时，κ = 0.02；低剂量胶原WBA时，κ = 0.08）。
总体一致性在35%至75%之间。LTA与VerifyNow在P2Y12-I反应方面显示出最高的一致性，其次是LTA与WBA之间的中度一致性。LTA与AspirinWorks在阿司匹林反应方面显示出中度一致性，而WBA与LTA和AspirinWorks的一致性最弱。本研究结果支持继续使用LTA监测双联抗血小板治疗，VerifyNow可作为P2Y12-I反应的合适替代方法。将这些不同检测平台获得的结果与患者预后相结合，对于未来研究仍然至关重要。
