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Analysis of Platelet Function Testing in Children Receiving Aspirin for Antiplatelet Effects

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Abstract

Aspirin (ASA) remains the most common antiplatelet agent used in children. VerifyNow Aspirin Test® (VN) assesses platelet response to ASA, with therapeutic effect defined by the manufacturer as ≤ 549 aspirin reaction units (ARU). Single-center, observational, analysis of 195 children (< 18 years-old) who underwent first VN between 2015 and 2020. Primary outcome was proportion of patients with ASA biochemical resistance (> 549 ARU). Secondary outcomes included incidence of new clinical thrombotic and bleeding events during ≤ 6 months from VN in those who received ASA monotherapy (n = 113). Median age was 1.8 years. Common indications for ASA included cardiac anomalies or dysfunction (74.8%) and ischemic stroke (22.6%). Median ASA dose before VN was 4.6 mg/kg/day. Mean VN was 471 ARU. ASA biochemical resistance was detected in 14.4% (n = 28). Of 113 patients receiving ASA monotherapy, 14 (12.4%) had a thrombotic event and 2 (1.8%) had a bleeding event. Mean VN was significantly higher at initial testing in patients experiencing thrombotic event compared to those without thrombosis (516 vs 465 ARU, [95% CI: 9.8, 92.2], p = 0.02). Multivariable analysis identified initial VN ASA result ≥ 500 ARU at initial testing as the only significant independent risk factor for thrombosis (p < 0.01). VN testing identifies ASA biochemical resistance in 14.4% of children. VN ASA ≥ 500 ARU rather than ≥ 550 ARU at initial testing was independently associated with increased odds of thrombosis. Designated cut-off of 550 ARU for detecting platelet dysfunction by ASA may need reconsideration in children.

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Authors and Affiliations

  1. Department of Pharmacy, Seattle Children’s Hospital, 4800 Sandpoint Way NE, Mailstop MB.5.420, Seattle, WA, 98105, USA

    David M. Newland, Michelle M. Palmer, Lisa R. Knorr & Jennifer L. Pak

  2. Pediatric Cardiology, Seattle Children’s Hospital, Seattle, WA, USA

    Erin L. Albers, Joshua M. Friedland-Little, Borah J. Hong, Yuk M. Law, Kathryn L. Spencer & Mariska S. Kemna

  3. School of Pharmacy, University of Washington, Seattle, WA, USA

    David M. Newland, Michelle M. Palmer, Lisa R. Knorr & Jennifer L. Pak

  4. School of Medicine, University of Washington, Seattle, WA, USA

    Erin L. Albers, Joshua M. Friedland-Little, Borah J. Hong, Yuk M. Law & Mariska S. Kemna

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  1. David M. Newland
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  2. Michelle M. Palmer
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  9. Kathryn L. Spencer
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Contributions

DMN, MMP, and MSK involved in study design, data acquisition, data analysis, interpretation of data, drafting, and revision of manuscript. LRK, JLP, ELA, JFL, BJH, YML, and KLS contributed to interpretation of data and revision of manuscript. All authors have approved the final article.

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Correspondence to David M. Newland.

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Newland, D.M., Palmer, M.M., Knorr, L.R. et al. Analysis of Platelet Function Testing in Children Receiving Aspirin for Antiplatelet Effects. Pediatr Cardiol 45, 614–622 (2024). https://doi.org/10.1007/s00246-023-03377-6

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  • DOI: https://doi.org/10.1007/s00246-023-03377-6

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