Evaluation of the Haemonetics TEG®® 5000 Platelet ... - NASCOLA
Evaluation of the Haemonetics TEG®® 5000 Platelet ... - NASCOLA
Evaluation of the Haemonetics TEG®® 5000 Platelet ... - NASCOLA
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<strong>Evaluation</strong> <strong>of</strong> <strong>the</strong> <strong>Haemonetics</strong><br />
TEG® <strong>5000</strong> <strong>Platelet</strong><br />
Mapping Method<br />
H<strong>of</strong>fman S*, Williams E, LaRose S, Cr<strong>of</strong>t R,<br />
Lawler D, and Wall-Donelan<br />
D<br />
Special Coagulation Laboratory<br />
University <strong>of</strong> Wisconsin Hospital and Clinics<br />
Presented by Suzanne M H<strong>of</strong>fman MT (ASCP)
• None<br />
Disclosure
Background<br />
• Anti-platelet agents are being used to<br />
treat an increasing number <strong>of</strong> medical<br />
conditions and during vascular procedures<br />
• Very few clinical assays are available to<br />
monitor <strong>the</strong>ir effectiveness in patients
Methods<br />
• Run <strong>Platelet</strong> Mapping on 10 normal donors<br />
• Compare Arachidonic Acid <strong>Platelet</strong> Mapping vs WBPA using<br />
normal donors on ASA<br />
• Compare Arachidonic Acid <strong>Platelet</strong> Mapping vs WBPA using<br />
naproxen spiked normal donor blood<br />
• Compare ADP <strong>Platelet</strong> Mapping vs WBPA using MeSamp<br />
(P2Y12 inhibitor) spiked normal donor blood<br />
• Compare AA and ADP <strong>Platelet</strong> Mapping vs WBPA on<br />
Interventional Radiology Patients<br />
• Compare our results with existing literature
<strong>Platelet</strong> Mapping Results on<br />
Healthy Adults<br />
Normal<br />
AA<br />
(% <strong>Platelet</strong>s Inhibited)<br />
1 NA (75.4—2 2 Naproxen<br />
Tabs)<br />
ADP<br />
(% <strong>Platelet</strong>s Inhibited)<br />
3.0<br />
2 0.0 0.0<br />
3 0.0 6.6<br />
4 0.0 6.4<br />
5 0.0 27.4<br />
6 0.0 25.7<br />
7 0.0 0.0<br />
8 0.0 8.2<br />
9 0.0 0.0<br />
10 0.0 0.0
AA <strong>Platelet</strong> Mapping vs <strong>Platelet</strong><br />
Aggregation using spiked Normals<br />
Donor<br />
and Normal taking Aspirin<br />
Meds or spike<br />
AA-WBPA<br />
(16-42 ohms)<br />
AA-Plt Map<br />
(% inhibition)<br />
1 2 - 81 mg ASA daily 0 93.7<br />
2<br />
325 mg ASA+<br />
Mefenamic Acid 0 99.2<br />
3 81 mg ASA-M,W,F 28 42.5<br />
4 2 IBU 3.5hr pre-draw 22 82.7<br />
5-pre 26 14<br />
5-post Spike 80µM Naproxen 0 50.1<br />
6-pre 39 0<br />
6-post Spike 80µM Naproxen 0 97
AA-WBPA vs AA-<strong>Platelet</strong> Mapping
AA <strong>Platelet</strong> Mapping vs WBPA Results<br />
Patients taking various ASA dosages<br />
100<br />
75<br />
WBPA Agg ohms<br />
50<br />
% PLT Inhibition<br />
25<br />
0<br />
0<br />
0<br />
0<br />
81<br />
81<br />
81<br />
162<br />
325<br />
325<br />
325<br />
325<br />
325<br />
325<br />
ASA Dosage
Arachidonic Acid <strong>Platelet</strong> Mapping<br />
(ASA) Results Comment<br />
• There is limited data available to assist in<br />
interpretation <strong>of</strong> <strong>the</strong>se results, and<br />
correlation <strong>of</strong> <strong>the</strong> test result with clinical<br />
information is strongly advised.<br />
• About 80% <strong>of</strong> individuals taking low-dose<br />
aspirin (81 mg/day) show at least 50%<br />
inhibition <strong>of</strong> arachidonic acid induced<br />
platelet aggregation.
ADP <strong>Platelet</strong> Mapping vs <strong>Platelet</strong><br />
Aggregation using Spiked Normals<br />
Donor<br />
Spike<br />
ADP-WBPA<br />
(11-41 ohms)<br />
ADP-Plt Map<br />
(% inhibition)<br />
7 2.5µM MeSAMP 11 29.1<br />
7 5.0µM MeSAMP 0 97.6<br />
8-pre No additives 11 22.3<br />
8 2.5µM MeSAMP 0 51.9<br />
8 5.0µM MeSAMP 0 78
ADP WBPA vs ADP <strong>Platelet</strong> Mapping
ADP <strong>Platelet</strong> Mapping vs WBPA Results<br />
Patients taking various Plavix®<br />
dosages<br />
100<br />
75<br />
50<br />
25<br />
WBPA Agg ohms<br />
% PLT Inhibition<br />
0<br />
0<br />
75<br />
75<br />
75<br />
75<br />
75<br />
75<br />
75<br />
150<br />
Plavix Dosage mg<br />
150<br />
150<br />
150<br />
225
ADP <strong>Platelet</strong> Mapping (Plavix®)<br />
Results Comment<br />
• There is limited data available to assist in interpretation<br />
<strong>of</strong> <strong>the</strong>se results, and correlation <strong>of</strong> <strong>the</strong> test result with<br />
clinical information is strongly advised.<br />
• The response to clopidogrel (Plavix®) ) as measured by<br />
this test is more variable than <strong>the</strong> response to aspirin.<br />
• In one study <strong>of</strong> individuals taking 75 mg/day <strong>of</strong><br />
clopidogrel, 40% <strong>of</strong> patients had less than 30%<br />
inhibition <strong>of</strong> ADP-induced aggregation, 25% had<br />
between 30-50% inhibition, and 35% had more than<br />
50% inhibition.
Conclusions<br />
There is no ideal method <strong>of</strong> assessing platelet<br />
function. <strong>Platelet</strong> testing is poorly standardized.<br />
The above comparison data suggests that<br />
TEG® <strong>Platelet</strong> Mapping Method correlates<br />
well with whole blood platelet aggregation<br />
(WBPA) testing. These data also support what<br />
is in <strong>the</strong> current literature on platelet inhibition<br />
testing using ADP and Arachidonic Acid. We<br />
plan on fur<strong>the</strong>r studies to determine <strong>the</strong> clinical<br />
relevance <strong>of</strong> <strong>the</strong>se test results.<br />
Reference: Agarwal et al. Quantifying <strong>the</strong> Effect <strong>of</strong> Antiplatelet Therapy. Anes<strong>the</strong>siology 2006;105:676-83.
Case Study:<br />
74 YO Neurology Patient with a Stroke admitted to <strong>the</strong><br />
hospital from <strong>the</strong> ER. Patient was taking 81 mg ASA ,<br />
<strong>5000</strong> U subq dalteparin, 325-650 mg acetaminophen, and<br />
10 mg Lipitor daily. Had been <strong>of</strong>f 75 mg Plavix® for 2 days
Case Study<br />
Same patient 6 days later. Patient taking 81 mg ASA, 75<br />
mg Plavix®, , and 10 mg Lipitor daily
Questions ????<br />
sh<strong>of</strong>fman@uwhealth.org