Measurement of residual platelet thrombogenicity under arterial shear conditions in cerebrovascular disease patients receiving antiplatelet therapy. (3rd August 2016)

• Record Type: Journal Article
• Authors: Yamazaki, M.; Ohnishi, T.; Hosokawa, K.; Yamaguchi, K.; Yoneyama, T.; Kawashima, A.; Okada, Y.; Kitagawa, K.; Uchiyama, S.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 14:Number 9(2016:Sep.)
• Page Start: 1788
• Page End: 1797
• Publication Date: 2016-08-03
• Subjects: aspirin -- blood flow velocity -- clopidogrel -- microfluidic microchips -- platelet function tests; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.13391
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract : Essentials A consensus methodology for assessing the effects of antiplatelet agents has not been established. Measuring platelet thrombus formation (PTF) for evaluating antiplatelet effects was assessed. PTF differentially reflected antiplatelet effects compared to other tests. PTF may be associated with the severity of carotid or intracranial arterial stenosis. Click to hear a presentation on platelet function testing in the clinic by Gresele and colleagues Summary: Background: A consensus methodology for assessing the effects of antiplatelet agents has not been established. Objective: We investigated the usefulness of directly measuring platelet thrombus formation (PTF) using a microchip‐based flow chamber system for evaluating antiplatelet therapy. Patients/Methods: Platelet thrombus formation in the whole blood of 94 patients with ischemic cerebrovascular disease treated with clopidogrel and/or aspirin was measured in a flow chamber system at a shear rate of 1500 s −1 and was compared with the results of assays for agonist‐induced platelet aggregability, phosphorylation of vasodilator‐stimulated phosphoprotein, platelet p‐selectin expression (PS), and platelet‐monocyte complexes. Results: In all patients tested, area under the flow pressure curve (AUC10), which represents platelet thrombogenicity, showed weak correlation with platelet aggregation induced by either adenosine diphosphate or collagen. In addition, AUC10 was lower in patients treated with dual antiplatelet therapy (median 79.4) compared with patients treated with aspirin or clopidogrel alone (217.7 and 301.0, respectively), whereas the parameters evaluated by the other assays did not reflect the combined treatment efficacy. In clopidogrel monotherapy patients, AUC10 was associated with the severity of arterial stenosis ( R 2 = 0.127, β = 1.25), and AUC10 and PS were higher in patients with severe carotid or intracranial arterial stenosis than in those with mild stenosis. Conclusions: Platelet thrombus formation measurement using a flow‐chamber system was useful for evaluating the efficacy of treatment with aspirin and clopidogrel, both alone and in combination. The present findings indicate that high residual platelet thrombogenicity in patients treated with clopidogrel may be associated with the severity of carotid or intracranial arterial stenosis.