Platelet function testing with best-in-class predictivity
- Anti-platelet drugs are among the most frequently administered drugs in modern medicine
- A combination of Aspirin with an ADP receptor antagonist is the mainstay anti-platelet therapy for patients with acute coronary syndromes (ACS) and/or coronary interventions with stent placement
- Impaired metabolisation of the drug (especially clopidogrel), comedications or other confounders can lead to a diminished anti-platelet response
- Multiplate`s ADPtest results show that up to 20% of patients do not respond adequately to clopidogrel treatment – with a 5-10 fold increased risk for stent thrombosis, stroke and q-wave myocardial infarction following percutaneous coronary interventions (PCI)
- The Multiplate system can support the monitoring and control of patients under anti-platelet therapy
Tailoring anti-platelet therapy in clinical routine - Multiplate analyzer
Detection principle: Multiplate® Electrode Aggregometry (MEA) based on an advancement of Cardinal and Flower’s 1979 impedance aggregometry method.
- Testing volume: 300 μL
- Sample material: whole blood
- Time to result: 10 minutes
- Units reported: area under the curve (AUC) in arbitrary units (AU*min or U)
- Relevant test thresholds:
- In patients treated with ADP receptor antagonists and undergoing percutaneous coronary intervention (PCI) values >46 U indicate high thrombotic risk as shown in a study with 1,608 CAD patients undergoing PCI compared to normal responders1
- Values <19 U in such patients are indicative of a high bleeding risk as shown in a study with 2,533 CAD patients scheduled for PCI2
1) Sibbing, D., et al., Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis. J Am Coll Cardiol, 2009. 53(10): p. 849-856.
2) Sibbing, D., et al., Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement. J Thromb Haemost, 2010. 8(2): p. 250-256.
Ease, quality and consistency
The ADPtest delivers benefits in a number of key areas:
Fast and easy assessment
- of platelet function from small volumes of whole blood
- for stratification of bleeding risk in surgical procedures
- for tailored anti-platelet therapy
- using standardized reagents and procedures
- More than 400 Medline publications, consensus papers with Multiplate and published guidelines for PFT
Bonello, L., Tantry, U.S., Marcucci, R., et al. (2010). Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol Sep 14;56(12):919-33.
In a recent consensus opinion on the definition of high on-treatment platelet reactivity (HPR) to ADP, studies are summarized that link HPR to ischemic events based on ROC curve derived cutoffs. The best prediction of ischemic risk was associated with the Multiplate® analyzer, with an odds ratio of 12.0, while studies using other methods demonstrated odds ratios of only 1.2 - 5.8.
Sibbing, D., Braun, S., Morath, T. et al. (2009). Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis. J Am Coll Cardiol;53:849–56.
This prospective trial evaluated if platelet reactivity to clopidogrel assessed with multiple electrode aggregometry (MEA, Multiplate®) correlates with
the risk of early drug-eluting stent thrombosis (ST). With 1,608 CAD patients enrolled who were scheduled for drug eluting stent PCI, this study is among the largest ones conducted on this topic. The primary end point was definite ST at 30 days. Before PCI, all patients received 600 mg clopidogrel. Blood was obtained directly before PCI and tested with the Multiplate® ADPtest more than 2 hours after clopidogrel loading. The upper 20% of patients according to Multiplate® measurements (n = 323)were defined as clopidogrel low responders using a cut-off value of 42 U.
This study has been featured in an article in “www.theheart.org” where Sibbing stated: “We can’t say whether the MEA assay is better than other assays or not, but we are very happy with it, and we are convinced by the results we have seen in this study. It also works out at a reasonable cost for each test. When we started this study, we were not routinely measuring platelet responsiveness in the cath lab, but now we are measuring it with this device“.
Siller-Matula, J. M., Francesconi, M., Dechant, C., Jilma, B., Maurer, G., Delle-Karth, G., et al. (2013). Personalized antiplatelet treatment after percutaneous coronary intervention: The MADONNA study. International journal of cardiology, 167(5), 2018-2023.
The MADONNA study is a prospective non-randomized non-blinded study with 798 patients on clopidogrel and undergoing PCI compared two cohorts (tailored and non-tailored treatment) with a follow-up of one month. Patients in the non-tailored cohort (n=395) received only one clopidogrel loading dose of 600 mg at least 2 h before PCI. In the tailored group (n=403) clopidogrel responsiveness was repeatedly determined via ADPtest using multiple electrode aggregometry (MEA) and non-responders (≥ 50 U) received repeated loading doses of clopidogrel or prasugrel. The MADONNA study of Siller-Matula et al.2 could prove that tailored anti-platelet treatment using Multiplate® results in an improved therapeutic efficacy with an equal safety compared to the standard treatment.
Weber, C.F., Görlinger, K., Meininger, D., Herrmann, E., Bingold, T., Moritz, A., Cohn, L.H., Zacharowski, K. (2012). Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients. Anesthesiology. Sep;117(3): 531-547.
This trial aimed to study the efficacy of hemostatic therapy guided either by conventional coagulation analyses (platelet count, hemoglobin concentration,
fibrinogen concentration, INR, aPTT) or point-of-care (POC) testing via Rotem® and Multiplate® in coagulopathic patients undergoing complex cardiac surgery. In this prospective study 100 patients with diffuse bleeding after heparin reversal or increased blood loss during the first 24 postoperative hours were randomized either to the conventional laboratory testing group (N=50) or POC-guided group (N=50).
Hemostatic therapy algorithms guided by the POC testing not only reduced patient exposure to allogenic blood products and decreased number of transfused units of packed erythrocytes but also lowered fresh frozen plasma and platelet concentrate usage. Further, POC-guided algorithm significantly improved clinical outcome and provided significant costs benefits compared to the standard treatment