Evaluation of the Haemonetics Evaluation of the Haemonetics TEGTEG®® 5000 Platelet 5000 Platelet MappingMapping™™ MethodMethod

Hoffman S*, Williams E, Hoffman S*, Williams E, LaRoseLaRose S, Croft R, S, Croft R, Lawler D, and WallLawler D, and Wall--DonelanDonelan DD

Special Coagulation LaboratorySpecial Coagulation LaboratoryUniversity of Wisconsin Hospital and ClinicsUniversity of Wisconsin Hospital and Clinics

Presented by Suzanne M Hoffman MT (ASCP)Presented by Suzanne M Hoffman MT (ASCP)

DisclosureDisclosure

NoneNone

BackgroundBackground

AntiAnti--platelet agents are being used to platelet agents are being used to treat an increasing number of medical treat an increasing number of medical conditions and during vascular proceduresconditions and during vascular procedures

Very few clinical assays are available to Very few clinical assays are available to monitor their effectiveness in patientsmonitor their effectiveness in patients

Run Platelet Mapping on 10 normal donorsRun Platelet Mapping on 10 normal donorsCompare Arachidonic Acid Platelet Mapping vs WBPA using Compare Arachidonic Acid Platelet Mapping vs WBPA using normal donors on ASAnormal donors on ASACompare Arachidonic Acid Platelet Mapping vs WBPA using Compare Arachidonic Acid Platelet Mapping vs WBPA using naproxen spiked normal donor bloodnaproxen spiked normal donor bloodCompare ADP Platelet Mapping vs WBPA using Compare ADP Platelet Mapping vs WBPA using MeSampMeSamp(P2Y12 inhibitor) spiked normal donor blood(P2Y12 inhibitor) spiked normal donor bloodCompare AA and ADP Platelet Mapping vs WBPA on Compare AA and ADP Platelet Mapping vs WBPA on Interventional Radiology PatientsInterventional Radiology PatientsCompare our results with existing literatureCompare our results with existing literature

MethodsMethods

Platelet Mapping Results on Platelet Mapping Results on Healthy AdultsHealthy Adults

NormalNormal AAAA(% Platelets Inhibited)(% Platelets Inhibited)

ADPADP(% Platelets Inhibited)(% Platelets Inhibited)

11 NA (75.4NA (75.4——2 Naproxen 2 Naproxen Tabs)Tabs)

3.03.0

22 0.00.0 0.00.0

33 0.00.0 6.66.6

44 0.00.0 6.46.4

55 0.00.0 27.427.4

66 0.00.0 25.725.7

77 0.00.0 0.00.0

88 0.00.0 8.28.2

99 0.00.0 0.00.0

1010 0.00.0 0.00.0

AA Platelet Mapping vs Platelet AA Platelet Mapping vs Platelet Aggregation using spiked Aggregation using spiked NormalsNormals

and Normal taking Aspirinand Normal taking AspirinDonor Meds or spike

AA-WBPA(16-42 ohms)

AA-Plt Map(% inhibition)

1 2 - 81 mg ASA daily 0 93.7

2325 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

AAAA--WBPA vs AAWBPA vs AA--Platelet MappingPlatelet Mapping

AA Platelet Mapping vs WBPA ResultsAA Platelet Mapping vs WBPA Results Patients taking various ASA dosagesPatients taking various ASA dosages

0

25

50

75

100

0 0 0 81 81 81 162

325

325

325

325

325

325

WBPA Agg ohms

% PLT Inhibition

ASA Dosage

Arachidonic Acid Platelet Mapping Arachidonic Acid Platelet Mapping (ASA) Results Comment(ASA) Results Comment

There is limited data available to assist in There is limited data available to assist in interpretation of these results, and interpretation of these results, and correlation of the test result with clinical correlation of the test result with clinical information is strongly advised.information is strongly advised.

About 80% of individuals taking lowAbout 80% of individuals taking low--dose dose aspirin (81 mg/day) show at least 50% aspirin (81 mg/day) show at least 50% inhibition of arachidonic acid induced inhibition of arachidonic acid induced platelet aggregation.platelet aggregation.

ADP Platelet Mapping vs Platelet ADP Platelet Mapping vs Platelet Aggregation using Spiked Aggregation using Spiked NormalsNormals

Donor SpikeADP-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 MappingADP WBPA vs ADP Platelet Mapping

ADP Platelet Mapping vs WBPA ResultsADP Platelet Mapping vs WBPA Results Patients taking various PlavixPatients taking various Plavix®®

dosagesdosages

0

25

50

75

100

0 75 75 75 75 75 75 75

150 150 150 150 225

WBPA Agg ohms% PLT Inhibition

Plavix Dosage mg

ADP Platelet Mapping (PlavixADP Platelet Mapping (Plavix®®)) Results CommentResults Comment

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

There is no ideal method of assessing platelet There is no ideal method of assessing platelet function. Platelet testing is poorly standardized. function. Platelet testing is poorly standardized. The above comparison data suggests that The above comparison data suggests that TEGTEG®® Platelet MappingPlatelet Mapping™™ MethodMethod correlates correlates well with whole blood platelet aggregation well with whole blood platelet aggregation (WBPA) testing. These data also support what (WBPA) testing. These data also support what is in the current literature on platelet inhibition is in the current literature on platelet inhibition testing using ADP and Arachidonic Acid. We testing using ADP and Arachidonic Acid. We plan on further studies to determine the clinical plan on further studies to determine the clinical relevance of these test results.relevance of these test results.

Reference: Reference: AgarwalAgarwal et al. Quantifying the Effect of Antiplatelet Therapy. Anestheset al. Quantifying the Effect of Antiplatelet Therapy. Anesthesiology 2006;105:676iology 2006;105:676--83.83.

ConclusionsConclusions

Case Study:Case Study: 74 YO Neurology Patient with a Stroke admitted to the 74 YO Neurology Patient with a Stroke admitted to the hospital from the ER. Patient was taking 81 mg ASA ,hospital from the ER. Patient was taking 81 mg ASA ,

5000 U 5000 U subqsubq dalteparin, 325dalteparin, 325--650 mg acetaminophen, and 650 mg acetaminophen, and 10 mg Lipitor daily. Had been off 75 mg Plavix10 mg Lipitor daily. Had been off 75 mg Plavix®® for 2 daysfor 2 days

Case StudyCase Study Same patient 6 days later. Patient taking 81 mg ASA, 75 Same patient 6 days later. Patient taking 81 mg ASA, 75

mg Plavixmg Plavix®®, and 10 mg Lipitor daily, and 10 mg Lipitor daily

Questions ????Questions ???? shoffman@uwhealth.orgshoffman@uwhealth.org