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European Heart Journal Advance Access published online on September 30, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn419
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease patients

Marie Lordkipanidzé1,2,3,{dagger}, Chantal Pharand1,2,3,{dagger}, Thuy Anh Nguyen1,3, Erick Schampaert2,4,5, Donald A. Palisaitis2,4,5 and Jean G. Diodati2,4,5,*

1 Faculty of Pharmacy, Université de Montréal, Montréal, Canada
2 Research Center, Hôpital du Sacré-Cœur de Montréal, 5400, boul. Gouin ouest, Montréal, Québec, Canada H4J 1C5
3 Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, 5400, boul. Gouin ouest, Montréal, Québec, Canada H4J 1C5
4 Faculty of Medicine, Université de Montréal, Montréal, Canada
5 Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, 5400, boul. Gouin ouest, Montréal, Québec, Canada H4J 1C5

Received 14 March 2008; revised 19 August 2008; accepted 28 August 2008.

* Corresponding author. Tel: +1 514 338 2200, Fax: +1 514 338 2694, Email: jean.gino.diodati{at}umontreal.ca

Aims: We investigated the comparability of platelet function tests in quantifying platelet inhibition achieved by clopidogrel.

Methods and results: This pre-specified substudy of a randomized, double-blind trial included 116 patients with stable coronary artery disease requiring diagnostic angiography. Patients received clopidogrel for 1 (300 or 600 mg) or 7 days (300 + 75 or 150 mg daily) before the procedure. Blood samples obtained before clopidogrel initiation and before diagnostic coronary angiography were assayed using light transmission aggregometry [adenosine diphosphate (ADP) 5 and 20 µM as the agonist], whole-blood aggregometry (ADP 5 and 20 µM), PFA-100® (Collagen-ADP cartridge), and VerifyNow® P2Y12. Although all assays studied were found sensitive to clopidogrel ingestion, none could distinguish categorically between patients who had, or not, ingested clopidogrel. Agreement between assays to identify patients with insufficient inhibition of platelet aggregation by clopidogrel was low.

Conclusion: The assessment of platelet function inhibition by clopidogrel is highly test-specific. Decision to increase clopidogrel dosage may vary on the basis of the assay used, thus highlighting the need for unambiguous guidelines with respect to assay selection, as platelet function assays are not interchangeable. At present, platelet function testing evaluating clopidogrel efficacy cannot be recommended in routine clinical practice.

Key Words: Platelet function testing • Platelet aggregation • Platelet analyzers • Clopidogrel • Responsiveness

{dagger} The first two authors have contributed equally to this work.


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