Evaluation of the Haemonetics TEG®® 5000 Platelet ... - NASCOLA

Evaluation of the Haemonetics
TEG® 5000 Platelet
Mapping Method
Hoffman S*, Williams E, LaRose S, Croft R,
Lawler D, and Wall-Donelan
D
Special Coagulation Laboratory
University of Wisconsin Hospital and Clinics
Presented by Suzanne M Hoffman MT (ASCP)

• None
Disclosure

Background
• Anti-platelet agents are being used to
treat an increasing number of medical
conditions and during vascular procedures
• Very few clinical assays are available to
monitor their effectiveness in patients

Methods
• Run Platelet Mapping on 10 normal donors
• Compare Arachidonic Acid Platelet Mapping vs WBPA using
normal donors on ASA
• Compare Arachidonic Acid Platelet Mapping vs WBPA using
naproxen spiked normal donor blood
• Compare ADP Platelet Mapping vs WBPA using MeSamp
(P2Y12 inhibitor) spiked normal donor blood
• Compare AA and ADP Platelet Mapping vs WBPA on
Interventional Radiology Patients
• Compare our results with existing literature

Platelet Mapping Results on
Healthy Adults
Normal
AA
(% Platelets Inhibited)
1 NA (75.4—2 2 Naproxen
Tabs)
ADP
(% Platelets Inhibited)
3.0
2 0.0 0.0
3 0.0 6.6
4 0.0 6.4
5 0.0 27.4
6 0.0 25.7
7 0.0 0.0
8 0.0 8.2
9 0.0 0.0
10 0.0 0.0

AA Platelet Mapping vs Platelet
Aggregation using spiked Normals
Donor
and Normal taking Aspirin
Meds or spike
AA-WBPA
(16-42 ohms)
AA-Plt Map
(% inhibition)
1 2 - 81 mg ASA daily 0 93.7
2
325 mg ASA+
Mefenamic Acid 0 99.2
3 81 mg ASA-M,W,F 28 42.5
4 2 IBU 3.5hr pre-draw 22 82.7
5-pre 26 14
5-post Spike 80µM Naproxen 0 50.1
6-pre 39 0
6-post Spike 80µM Naproxen 0 97

AA-WBPA vs AA-Platelet Mapping

AA Platelet Mapping vs WBPA Results
Patients taking various ASA dosages
100
75
WBPA Agg ohms
50
% PLT Inhibition
25
0
0
0
0
81
81
81
162
325
325
325
325
325
325
ASA Dosage

Arachidonic Acid Platelet Mapping
(ASA) Results Comment
• There is limited data available to assist in
interpretation of these results, and
correlation of the test result with clinical
information is strongly advised.
• About 80% of individuals taking low-dose
aspirin (81 mg/day) show at least 50%
inhibition of arachidonic acid induced
platelet aggregation.

ADP Platelet Mapping vs Platelet
Aggregation using Spiked Normals
Donor
Spike
ADP-WBPA
(11-41 ohms)
ADP-Plt Map
(% inhibition)
7 2.5µM MeSAMP 11 29.1
7 5.0µM MeSAMP 0 97.6
8-pre No additives 11 22.3
8 2.5µM MeSAMP 0 51.9
8 5.0µM MeSAMP 0 78

ADP WBPA vs ADP Platelet Mapping

ADP Platelet Mapping vs WBPA Results
Patients taking various Plavix®
dosages
100
75
50
25
WBPA Agg ohms
% PLT Inhibition
0
0
75
75
75
75
75
75
75
150
Plavix Dosage mg
150
150
150
225

ADP Platelet Mapping (Plavix®)
Results Comment
• There is limited data available to assist in interpretation
of these results, and correlation of the test result with
clinical information is strongly advised.
• The response to clopidogrel (Plavix®) ) as measured by
this test is more variable than the response to aspirin.
• In one study of individuals taking 75 mg/day of
clopidogrel, 40% of patients had less than 30%
inhibition of ADP-induced aggregation, 25% had
between 30-50% inhibition, and 35% had more than
50% inhibition.

Conclusions
There is no ideal method of assessing platelet
function. Platelet testing is poorly standardized.
The above comparison data suggests that
TEG® Platelet Mapping Method correlates
well with whole blood platelet aggregation
(WBPA) testing. These data also support what
is in the current literature on platelet inhibition
testing using ADP and Arachidonic Acid. We
plan on further studies to determine the clinical
relevance of these test results.
Reference: Agarwal et al. Quantifying the Effect of Antiplatelet Therapy. Anesthesiology 2006;105:676-83.

Case Study:
74 YO Neurology Patient with a Stroke admitted to the
hospital from the ER. Patient was taking 81 mg ASA ,
5000 U subq dalteparin, 325-650 mg acetaminophen, and
10 mg Lipitor daily. Had been off 75 mg Plavix® for 2 days

Case Study
Same patient 6 days later. Patient taking 81 mg ASA, 75
mg Plavix®, , and 10 mg Lipitor daily

Questions ????
shoffman@uwhealth.org