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Role of the laboratory in monitoring patients receiving dual antiplatelet therapy
Author(s) -
VIDALI M.,
ROLLA R.,
PARRELLA M.,
CASSANI C.,
MANZINI M.,
PORTALUPI M. R.,
SERINO R.,
PRANDO M. D.,
BELLOMO G.,
PERGOLINI P.
Publication year - 2012
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/j.1751-553x.2012.01428.x
Subject(s) - medicine , clopidogrel , aspirin , antiplatelet drug , gastroenterology
Summary Introduction: The increasing demand for therapeutic monitoring in patients receiving antiplatelet therapy has been paralleled by the development of instruments and tests whose clinical usefulness is still under debate. We devised a laboratory approach to detect patients with antiplatelet resistance at risk to develop thrombotic events. Methods: One hundred and eighty patients, under aspirin and clopidogrel after angioplasty and stent implantation, were studied by PFA100 ® with collagen/epinephrine (CoEPI, cutoff 165s) cartridge and by Multiplate ® using arachidonic acid (ASPItest, pos < 862AUC), ADP (ADPtest, pos < 417AUC), and collagen (COLtest, pos < 607AUC). Results: Only 67 of 173 patients with ASPI < 862 displayed a prolonged CoEPI and up to 65 patients had normal CoEPI despite ASPI < 300. Patients with ASPI < 300 had significantly lower COL than patients with ASPI > 300. One hundred and thirty‐eight patients displaying ADP < 417 had significantly lower COL than those with ADP > 417. Association between COL and ADP remained after ASPI stratification: in patients with suboptimal (ASPI 300–892) or maximal (ASPI < 300) response to aspirin, having ADP < 417 (clopidogrel responsive) increased COL positivity, respectively, from 9.5 to 58.8% and from 47.6 to 82.7%. Conclusion: A combination of specific tests may be useful in identifying higher‐risk patients with poor compliance or drug resistance who potentially may benefit from therapy change.