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The Use of the Point of Care Helena ICHOR/Plateletworks® and the Accumetrics Ultegra® RPFA for Assessment of Platelet Function with GPIIb-IIIa Antagonists

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Abstract

Objective: To evaluate a newly modified rapid platelet function analysis system (ICHOR/ Plateletworks®) and to compare the results obtained with those of traditional light transmission aggregometry (LTA), and the Ultegra/RPFA® system.

Background: Anti-platelet therapy is standard of care for patients as an adjunct to percutaneous coronary intervention (PCI) or for medical management of non-ST elevation acute coronary syndromes (NSTE ACS). Recent clinical trial results suggest that the three currently approved platelet GPIIb-IIIa receptor antagonists, eptifibatide, tirofiban and abciximab, may vary in extent of inhibition of platelet aggregation (IPA) at the approved doses. Thus, pharmacodynamic evaluations of these agents to determine the extent of platelet function inhibition, especially during the periprocedural time of a cardiac intervention, are necessary. A rapid measurement method as a surrogate for LTA, the current gold standard, would be ideal in order to have the option for dose monitoring or adjustment prior to or during an intervention. The Helena ICHOR/ Plateletworks® may be useful for point of care testing.

Methods: Blood samples collected in D-Phe-Pro-Arg-chloromethyl ketone dihydrochloride (PPACK) anticoagulant were treated with increasing concentrations of eptifibatide, tirofiban or abciximab. LTA was carried out in conjunction with the ICHOR/Plateletworks®, using a modified method, and Accumetrics Ultegra® with RPFA cartridges.

Results: This study demonstrated that platelet inhibition measured by the ICHOR/Plateletworks® mirrored the level of IPA obtained with LTA. In contrast, the Ultegra® system had less correlation when compared to LTA at inhibition levels < 90%.

Conclusions: Based on these data, the ICHOR/ Plateletworks® utilized under modified guidelines may serve as a surrogate for LTA when rapid measurements are necessary.

Abbreviated Abstract

A rapid platelet function measurement method as a surrogate for light transmission aggregometry (LTA), the current gold standard, is ideal in order to have the option for GPIIb-IIIa antagonist dose monitoring or adjustment prior to or during a coronary intervention. A newly modified rapid platelet function analysis system (ICHOR/Plateletworks® was evaluated and compared to the results obtained with traditional light transmission aggregometry (LTA), and the Ultegra/RPFA® system. Blood samples collected in D-Phe-Pro-Arg-chloromethyl ketone dihydrochloride (PPACK) anticoagulant were treated with increasing concentrations of eptifibatide, tirofiban or abciximab. LTA was carried out in conjunction with the ICHOR/Plateletworks®, using a modified method, and Accumetrics Ultegra® with RPFA cartridges. Based on these data, the ICHOR/Plateletworks® utilized under modified guidelines may serve as a surrogate for LTA when rapid measurements are necessary.

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Authors and Affiliations

  1. The Vascular Biology Center of Excellence and the Departments of Medicine, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Melanie M. White BA, Rajini Krishnan BS, Teddi J. Kueter BS, Mary V. Jacoski MS & Lisa K. Jennings PhD

  2. The Vascular Biology Center of Excellence and the Departments of Molecular Sciences, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Lisa K. Jennings PhD

  3. The Vascular Biology Center of Excellence and the Departments of Surgery, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Lisa K. Jennings PhD

  4. Vascular Biology Center of Excellence, The University of Tennessee Health Science Center, 956 Court Avenue, Coleman Building H300, Memphis, TN, 38163, USA

    Lisa K. Jennings PhD

Authors
  1. Melanie M. White BA
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  2. Rajini Krishnan BS
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  3. Teddi J. Kueter BS
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  4. Mary V. Jacoski MS
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  5. Lisa K. Jennings PhD
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Corresponding author

Correspondence to Lisa K. Jennings PhD.

Additional information

Supported in part by Helena Laboratories, Inc. and the University of Tennessee Health Science Center Vascular Biology Center of Excellence

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White, M.M., Krishnan, R., Kueter, T.J. et al. The Use of the Point of Care Helena ICHOR/Plateletworks® and the Accumetrics Ultegra® RPFA for Assessment of Platelet Function with GPIIb-IIIa Antagonists. J Thromb Thrombolysis 18, 163–169 (2004). https://doi.org/10.1007/s11239-005-0341-x

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  • DOI: https://doi.org/10.1007/s11239-005-0341-x

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