Relation between the vasodilator-stimulated phosphoprotein phosphorylation assay and light transmittance aggregometry in East Asian patients after high-dose clopidogrel loading - 29/06/13
, Udaya S. Tantry, PhD b, Yongwhi Park, MD, PhD c, Dong-Hyun Lee, BS d, Kevin P. Bliden, MBA b, Jin-Sin Koh, MD c, Jeong Rang Park, MD, PhD c, Jae-Sik Jang, MD, PhD e, Seok-Jae Hwang, MD, PhD c, Eun-Ha Koh, MD, PhD d, Choong Hwan Kwak, MD, PhD c, Jin-Yong Hwang, MD, PhD c, Sunjoo Kim, MD, PhD d, Paul A. Gurbel, MD bRésumé |
Objectives |
We analyzed the relation between platelet aggregation measured by light transmittance aggregometry (LTA) and platelet reactivity index (PRI) measured by vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay.
Background |
It has been suggested that LTA and VASP-P assay correlate differently according to the level of P2Y12 receptor blockade by thienopyridines.
Methods |
We simultaneously measured platelet function by LTA and VASP-P assay in 466 East Asians undergoing elective percutaneous coronary intervention after a 600-mg clopidogrel loading. High on-clopidogrel platelet reactivity (HPR) was defined by published consensus criteria.
Results |
The degree of correlation between LTA and the VASP-P assay was different according to PRI levels. The correlation was lower in patients with poor responsiveness (PRI >60%) (n = 216) (0.035 ≤ r2 ≤ 0.047), which was greater in responsive patients (PRI ≤60%) (n = 250) (0.315 ≤ r2 ≤ 0.526). Despite a 600-mg loading, East Asians had a high prevalence of HPR (40.1%-63.5%), and the prevalence of HPR also differed between LTA and VASP-P assay. A PRI cutoff of >58% (area under curve, 0.829; 95% confidence intervals, 0.792-0.862; P < .001) corresponded to the published HPR cutoff by 5-μM adenosine diphosphate–induced maximal platelet aggregation >46%.
Conclusions |
This is the largest study correlating platelet reactivity measured by LTA and VASP-P assay in a percutaneous coronary intervention–treated cohort. The correlation is dependent on the level of responsiveness. Future investigations are needed to better define the optimal cutoffs of HPR measured by LTA and VASP-P assay for personalized antiplatelet therapy.
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Vol 166 - N° 1
P. 95-103 - juillet 2013 Retour au numéro
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