(Circulation. 2001;103:1488.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Testing Platelet Activation With a Shear-Dependent Platelet Function Test Versus Aggregation-Based Tests
Relevance for Monitoring Long-Term Glycoprotein IIb/IIIa Inhibition
From the Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, and the Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Aviv, Israel (D.V.).
Correspondence to Juan Jose Badimon, PhD, Director, Cardiovascular Biology Research Laboratory, Cardiovascular Institute, Box 1030, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029. E-mail juan.badimon{at}mssm.edu
Background—Tests developed to monitor glycoprotein (GP) IIb/IIIa blockade do not properly reflect platelet function in vivo and need a baseline (pretreatment) value. Because GP IIb/IIIa is essential in platelet aggregation and thrombosis under shear conditions, a flow-dependent approach to monitor its inhibition can be used.
Methods and Results—We compared a test based on flow-dependent platelet deposition, the Cone and Platelet Analyzer (CPA), with in vitro platelet aggregometry and the Rapid Platelet Function Assay (RPFA) on platelet function after GP IIb/IIIa inhibition. In vitro, increasing concentrations of abciximab (0% to 100% receptor occupancy) were tested. Ex vivo, platelet function was monitored with the CPA and with aggregometry for up to 1 week after abciximab administration. The CPA was better correlated with the percentage of free GP IIb/IIIa receptors than was aggregometry or the RPFA. Only the RPFA, when expressed as a ratio over baseline (pretreatment), was comparable to the CPA. Ex vivo, the CPA, but not aggregometry, showed prolonged platelet inhibition with gradual recovery from GP IIb/IIIa receptor blockade in the first week after abciximab administration.
Conclusions—Platelet function assessment by shear-induced deposition is a reliable test to monitor a wide range of GP IIb/IIIa inhibition. Its accuracy does not require a baseline reference. The effects of GP IIb/IIIa blockade on platelet function should be examined under high shear conditions.
Key Words: platelets • tests • drugs
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