George substituted for Dave McGlasson and presented, “Monitoring the New Antithrombotics: Whatever Happened to the PT and PTT?“ on Wednesday, April 3, 10 AM; and “Antiplatelet Therapy, Do Aspirin and Plavix Work?” on Thursday, April 3, 2:30–2:30 PM at the Great Plains Regional Laboratory Expo in Omaha Nebraska. His presentation handouts, in PDF, appear on our Audio Modules page. Thanks to all who participated in these presentations, and please feel free to post any follow-up questions or comments to George through this web site.
Prof. Bernadette Rodak of Indiana University forwarded a question about parallel anticoagulant and antiplatelet therapy from the ASCLS Consumer Web Forum. In the interest of confidentiality, I paraphrase the question:
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This is a February 18 follow-up from the individual whom I responded to in a January 30 post entitled Clopidogrel Efficacy. I had collaborated with Prof. Bernadette Rodak of Indiana University on the original email to the questioner. Here is the comment (with identification removed):
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This question arrived last week in the American Society for Clinical Laboratory Science Consumer Forum: “I would like to know the differences between platelet aggregation testing and pharmacogenetic testing of CYP2C19 for clopidogrel. In 2010, the FDA issued a black box warning for clopidogrel in persons who are CYP2C19 poor metabolizers. I am very interested in what the results for both tests reveal and when these tests would be appropriate. Thank you.”
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Attached to the December 28 post, “Platelet Function Testing and the Bleeding Time” with the AC Ivy story was the question, “Is the Accumetrics VerifyNow aggregometer useful for screening patients for inherited platelet function disorders?” Yes, I consider the VerifyNow assay effective in screening for platelet function defects, like storage pool disorder or platelet secretion disorder (aspirin-like syndrome), however I find no reference to this function on the Accumetrics web site, which highlights only their FDA-cleared assays for aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitor efficacy. Consequently, I have placed an inquiry with the company’s technical service department and will post their answer when it arrives.
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Here is a link to a recent TRILOGY ACS report indicating that prasugrel (Effient) is equivalent to clopidogrel (Plavix) in reducing major cardiovascular events.
I received this truncated communication on July 16 from Michael Suter with no follow-up, but I post it regardless, as Accumetrics’ decision to change their P2Y12 cartridge report seems to be a concern for many:
“We monitor Plavix therapy using the VerifyNow P2Y12 assay kit. Accumetrics is in the process of discontinuing the reporting of percent inhibition, leaving the PRU value as the only reported result. There is good documentation of the cutoff for effective therapy…” (message ends)
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Participants: what method, if any, do you use for monitoring Plavix? The ones I know about are light transmittance aggregometry using ADP as the agonist, impedance aggregometry with ADP, INNOVANCE PFA-100 P2Y ( RUO), Accumetrics Integra VerifyNow P2Y12, the Multiplate analyzer (RUO), or the thromboelastograph (TEG). If you are using one of the point of care methods, such as PFA-100 or VerifyNow, how do you validate the assay?
Anticoagulant Therapy, Antiplatelet Therapy | George Fritsma | 
April 4, 2013 5:59 am | 
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