Why the study?
Is the platelet aggregation response to ADP highly variable in normal donors and patients on aspirin alone, potentially confounding the assessment of P2Y12 inhibition?
Is the platelet aggregation response to ADP highly variable in normal donors and patients on aspirin alone, potentially confounding the assessment of P2Y12 inhibition?
A significant proportion of healthy individuals and patients on aspirin alone exhibit baseline platelet aggregation responses to ADP that mimic a therapeutic response to P2Y12 inhibitors, highlighting the high baseline variability of this assay and potentially explaining the failure of guided therapy trials.
Baseline ADP aggregation variability risks misclassifying P2Y12 response; leaves open whether current thresholds need refinement in future studies.
BACKGROUND: P2Y12 inhibitors are indicated in patients following percutaneous coronary intervention. Several studies have demonstrated that high on treatment platelet reactivity is correlated with outcomes yet prospective studies of guided therapy have failed to show benefit. There is a paucity of studies on the platelet aggregation response to ADP before P2Y12 therapy is started. The aim of this study was to characterize platelet responses to 20 μM ADP by light transmission aggregometry (LTA) in a homogenous population. METHODS: Platelet aggregation was assessed in 201 patients on dual antiplatelet therapy, 98 patients on aspirin alone and 47 normal, healthy volunteers free from anti-platelet medication. RESULTS: Consensus guidelines suggest that a platelet aggregation response in response to the agonist ADP of <57% is an adequate therapeutic response to P2Y12 inhibition. Seven healthy donors and 38 patients taking aspirin only had aggregation responses below 57%. CONCLUSIONS: The results of our study demonstrate that 15% of normal donors and 38% of patients taking aspirin only would be classified as having a therapeutic response to P2Y12 inhibition using current guidelines.
No takes yet. Share an insight, caveat, or question.
Dunne et al. (2015) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: