Korean J Lab Med.  2010 Oct;30(5):460-468. 10.3343/kjlm.2010.30.5.460.

Determination of the Prevalence of Aspirin and Clopidogrel Resistances in Patients with Coronary Artery Disease by using Various Platelet-function Tests

• Woo KS
• Kim BR
• Kim JE
• Goh RY
• Yu LH
• Kim MH
• Han JY

• KMID: 1022035
• DOI: http://doi.org/10.3343/kjlm.2010.30.5.460

Abstract

BACKGROUND
Dual therapy with aspirin and clopidogrel has emerged as the gold standard therapy for patients treated with drug-eluting stents (DES). However, there is variability in patients' responses to this antiplatelet therapy, and some patients continue to show ischemic recurrences after therapy. The purpose of the study was to compare the simultaneously obtained results of various platelet-function tests for assessing the prevalence of antiplatelet resistance in coronary artery disease patients undergoing DES therapy.
METHODS
A total of 66 patients were administered a loading dose of aspirin, clopidogrel, and cilostazol at least 12 hr before stenting. The results of VerifyNow (Accumetrics, USA), multiplate analyzer (Dynabyte Medical, Germany), and vasodilator-stimulated phosphoprotein/P2Y12 (Biocytex, France) assays were compared with those of light transmission aggregometry (LTA) analysis.
RESULTS
The P2Y12 reaction units and P2Y12% inhibition values obtained using the VerifyNow assay showed strong correlation (r) with the results of the LTA analysis. All tests results showed low concordance in defining the antiplatelet resistance in patients, and the degrees of agreement were as follows: 0 for aspirin reaction units; 0.25, P2Y12% inhibition; 0, aspirin-sensitive patients' identification test; 0.21, ADPtest; and 0.14, platelet reactivity index, expressed as the kappa statistics. The prevalence of aspirin and clopidogrel resistances in patients resulted in remarkable variations, from 0% to 22.7% and from 9.1% to 48.5%, respectively.
CONCLUSIONS
The clinical usefulness of the different assays for the correct classification of patients in terms of antiplatelet resistance remains unclear. Further studies are required to determine the best method for correlating the occurrences of adverse ischemic events.

Keyword

Aspirin; Clopidogrel; Resistance; Platelet-function tests

MeSH Terms

Aged
Aspirin/*administration & dosage
Coronary Artery Disease/*drug therapy
Drug Resistance
Drug Therapy, Combination
Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Platelet Aggregation/drug effects
Platelet Aggregation Inhibitors/*administration & dosage
Platelet Function Tests
Purinergic P2Y Receptor Antagonists/administration & dosage
Receptors, Purinergic P2Y12/metabolism
Tetrazoles/administration & dosage
Ticlopidine/administration & dosage/*analogs & derivatives

Figure

• 

  Fig. 1. Distribution of platelet aggregation results of various platelet-function tests and correlations between the results obtained from the various platelet-function tests and those of LTA analysis. (A) Platelet aggregation measured by LTA analysis. (B) ARU value measured by VerifyNow assay and its comparison with the result of LTA analysis performed using AA as the agonist. (C) PRU measured by using VerifyNow and its comparison with the result of LTA analysis performed using ADP as the agonist. (D) P2Y12% inhibition measured by using VerifyNow and its comparison with the result of the LTA analysis performed using ADP as the agonist. (E) ASPItest performed using multiplate analyzer and its comparison with the LTA analysis performed using AA as the agonist. (F) ADPtest performed using multiplate analyzer and its comparison with LTA analysis performed using ADP as the agonist. (G) PRI measured by using VASP/P2Y12 assay and its comparison with the result of the LTA analysis performed using ADP as the agonist. Abbreviations: LTA, light transmission aggregometry; ARU, aspirin reaction units; AA, arachidonic acid; PRU, P2Y12 reaction units; VASP, vasodilator-stimulated phosphoprotein; ASPI, aspirin-sensitive patients identification.

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