Ann Lab Med.  2019 Jan;39(1):23-30. 10.3343/alm.2019.39.1.23.

Effectiveness of Platelet Function Analyzer-100 for Laboratory Detection of Anti-Platelet Drug-Induced Platelet Dysfunction

• Kweon OJ
• Lim YK
• Kim B
• Lee MK
• Kim HR

• KMID: 2420267
• DOI: http://doi.org/10.3343/alm.2019.39.1.23

Abstract

BACKGROUND
High on-treatment platelet reactivity (HTPR) is the phenomenon wherein patients exhibit normal platelet activity in laboratory testing despite adequate adherence to anti-platelet treatment. We investigated the detection rates of Platelet Function Analyzer (PFA)-100 (Dade Behring AG, Düdingen, Switzerland) for drug-induced platelet dysfunction and analyzed potential contributors to HTPR with practical PFA-100 data over six years.
METHODS
We used data from 6,957 patients who underwent PFA-100 testing after receiving aspirin, clopidogrel, or non-steroidal anti-inflammatory drugs (NSAIDs). Of these, 6,163 patients were tested with only the collagen/epinephrine cartridge (Col/EPI) of PFA-100; 794 were tested with both Col/EPI and the collagen/ADP cartridge (Col/ADP). We calculated PFA-100 closure time (CT) for each drug and compared the clinical and laboratory characteristics of the patients with prolonged CTs and normal CTs (i.e., HTPR).
RESULTS
In Col/EPI, 73.2% (365/499), 72.6% (390/537), and 55.3% (3,442/6,228) patients showed prolonged CTs for aspirin, clopidogrel, and NSAIDs, respectively. In Col/ADP, prolonged CTs were observed in 37.4% (34/91), 43.2% (35/81), and 29.6% (200/676) of patients receiving aspirin, clopidogrel, and NSAIDs, respectively. Of the patients tested with both cartridges, 88.9% (48/54), 95.3% (41/43), and 89.0% (577/648) of the patients receiving aspirin, clopidogrel, and NSAIDs had prolonged CTs, and 10.0% (79/794) showed normal CTs regardless of drugs. For clopidogrel users (both cartridges), there were more patients with malignancies in the normal CT than prolonged CT group.
CONCLUSIONS
PFA-100 is not sufficiently effective for laboratory screening of drug-induced platelet dysfunction. Malignancy may contribute to clopidogrel-related HTPR in PFA-100.

Keyword

Platelet Function Analyzer-100; Aspirin; Clopidogrel; Non-steroidal anti-inflammatory drugs; High on-treatment platelet reactivity

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Blood Platelets*
Humans
Mass Screening
Anti-Inflammatory Agents, Non-Steroidal
Aspirin

Figure

• 

  Fig. 1 Selection and drug status of study population, from March 2010 to April 2016.Abbreviations: PFA-100, Platelet Function Analyzer-100; NSAIDs, non-steroidal anti-inflammatory drugs; Col/EPI, collagen/epinephrine cartridge; Col/ADP, collagen/ADP cartridge.

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