Detection of clopidogrel resistance by MEA and LTA

Summary

Antiaggregation therapy is still the most frequently used approach to prevent thrombotic events in cardiovascular disease. It has a good clinical effect but there is increasing evidence of high residual platelet aggregation activity in a number of patients. Laboratory methods only allow us to detect clopidogrel “non-responders” or “low responders”. Recent methods are based on monitoring residual platelet aggregation activity (aggregation methods) or detecting the number of free epitopes for binding a specific monoclonal antibody such as vasodilator-stimulated phosphoprotein phosphorylation (VASP). The aim of our study was the comparison of light transmission aggregometry (LTA) and multiple electrode platelet aggregometry (MEA) with induction by ADP at concentrations of 20 μmol/L with or without prostaglandin E1 (PGE₁). In the studied group of 84 patients with cardiovascular disease (CAD), an impaired individual response to clopidogrel therapy was detected by MEA and LTA in 11.9% and 10.7%, respectively. The LTA and MEA methods with induction by ADP with PGE₁ and without PGE₁ were statistically compared using Spearman’s nonparametric correlation analysis. Both methods using PGE₁ have a positive significant correlation (P=0.003) in contrast to the results without PGE₁ with no significant correlation (P=0.732).

The sensitivity of clopidogrel resistance detection correlates well with other data in literature suggesting that there are 5% - 30% of clopidogrel low-responders depending on the type of platelet function assay used and the criteria for defining a low-responder. These results favour implementation of the ADP test with PGE₁ by MEA specifically for the identification of low-responders on clopidogrel.

Key words:
antiplatelet therapy, clopidogrel, multiple electrode aggregometry, platelet aggregation

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