Minka J A Vries1, Heleen J Bouman2, Renske H Olie2,3, Leo F Veenstra4, Suzanne Zwaveling5, Paul W M Verhezen6, Arina J Ten Cate-Hoek5,3, Hugo Ten Cate5,2,3, Yvonne M C Henskens5,6, Paola E J van der Meijden5,3. 1. Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands m.vries@maastrichtuniversity.nl. 2. Department of Internal Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands. 3. Thrombosis Expertise Centre, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands. 4. Department of Cardiology, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands. 5. Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. 6. Central Diagnostic Laboratory, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
Abstract
AIMS: Therapeutic windows for residual platelet reactivity in patients with coronary artery disease on P2Y12 inhibitors were proposed in a consensus document. We aimed to explore the level of agreement between windows for different platelet function tests (PFTs) used to classify patients in low, optimal, and high on-treatment platelet reactivity categories, and to identify variables contributing to the level of agreement. METHODS AND RESULTS: In this explorative clinical study, the VerifyNow P2Y12, Multiplate adenosine diphosphate (ADP), and light transmission aggregometry (LTA) 20 μmol/L ADP were performed simultaneously in 145 consecutive vulnerable patients. Measurements were performed within 6 months of percutaneous intervention. Patients were considered vulnerable if they had ≥2 risk factors for bleeding or ischaemic events. Window-agreement between PFT pairs was slight to moderate. Multiplate-VerifyNow agreed in 72 patients (50%), κ = 0.41; VerifyNow-LTA agreed in 76 patients (52%), κ = 0.36; and LTA-Multiplate agreed in 64 patients (44%), κ = 0.20. Several variables including the type of P2Y12 inhibitor, aspirin, haemoglobin level, platelet count, age, and previous stroke significantly influenced agreement between PFTs. CONCLUSIONS: Our results suggest that the PFTs, with accompanying therapeutic windows, are not interchangeable when determining the response to antiplatelet therapy in vulnerable coronary artery disease patients on P2Y12 inhibitors. Hence, the type of PFT can directly affect the treatment strategy, which may be especially relevant for patients with multiple factors influencing individual PFTs and thereby test agreement. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Therapeutic windows for residual platelet reactivity in patients with coronary artery disease on P2Y12 inhibitors were proposed in a consensus document. We aimed to explore the level of agreement between windows for different platelet function tests (PFTs) used to classify patients in low, optimal, and high on-treatment platelet reactivity categories, and to identify variables contributing to the level of agreement. METHODS AND RESULTS: In this explorative clinical study, the VerifyNow P2Y12, Multiplate adenosine diphosphate (ADP), and light transmission aggregometry (LTA) 20 μmol/L ADP were performed simultaneously in 145 consecutive vulnerable patients. Measurements were performed within 6 months of percutaneous intervention. Patients were considered vulnerable if they had ≥2 risk factors for bleeding or ischaemic events. Window-agreement between PFT pairs was slight to moderate. Multiplate-VerifyNow agreed in 72 patients (50%), κ = 0.41; VerifyNow-LTA agreed in 76 patients (52%), κ = 0.36; and LTA-Multiplate agreed in 64 patients (44%), κ = 0.20. Several variables including the type of P2Y12 inhibitor, aspirin, haemoglobin level, platelet count, age, and previous stroke significantly influenced agreement between PFTs. CONCLUSIONS: Our results suggest that the PFTs, with accompanying therapeutic windows, are not interchangeable when determining the response to antiplatelet therapy in vulnerable coronary artery diseasepatients on P2Y12 inhibitors. Hence, the type of PFT can directly affect the treatment strategy, which may be especially relevant for patients with multiple factors influencing individual PFTs and thereby test agreement. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: M Urooj Zafar; Donald A Smith; Usman Baber; Samantha Sartori; Kevin Chen; David W Lam; Carlos A Linares-Koloffon; Juan Rey-Mendoza; Gustavo Jimenez Britez; Gines Escolar; Valentin Fuster; Juan J Badimon Journal: Circ Cardiovasc Interv Date: 2017-08 Impact factor: 6.546
Authors: C P D M de Breet; S Zwaveling; M J A Vries; R G van Oerle; Y M C Henskens; A W J Van't Hof; P E J van der Meijden; L Veenstra; H Ten Cate; R H Olie Journal: Front Cardiovasc Med Date: 2021-06-10