Clopidogrel Platelet Function Tests

Learning Objectives

December 2011

The objectives of this presentation include an overview of the currently available testing for platelet function in patients on clopidogrel, which has the trade name Plavix in the United States. I will discuss briefly some of the characteristics of each test and how to select testing appropriate for your laboratory. I will review 2 years of data concerning clopidogrel resistance testing at our institution in Jacksonville, Florida. In conclusion I will describe the controversy concerning genetic testing for polymorphisms in the P450 gene thought to be primarily responsible for clopidogrel metabolism.

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• Introduction
• Learning Objectives
• Platelet Function Tests for the Detection of Clopidogrel Resistance¹
• Platelet Function Tests for the Detection of Clopidogrel Resistance
• Caveat: There Is No Perfect Platelet Function Test...
• Problems With Testing For Clopidogrel
• How We Choose a Testing Method
• Methodology Table
• Platelet Function Testing Available at Mayo Clinic Florida
• Light Transmission Platelet Aggregometry Studies (LTA)
• Platelet Aggregation (Cont'd)
• Normal Patient
• Accumetrics VerifyNow Test
• VerifyNow P2Y₁₂ Test
• P2Y₁₂ Test Interferences
• P2Y₁₂ Antagonists²
• Can These Platelet Function Tests Be Used for Ticagrelor (Brilinta/Brilique)?
• PFA-100
• PFA–100 (Cont'd)
• INNOVANCE PFA P2Y
• TEG — Platelet Mapping
• Results of VerifyNow Testing
• 2009–2011 Clopidogrel Response at 30%
• Genetic Testing: Clopidogrel Metabolism
• Clopidogrel Metabolism
• Number of Gene Polymorphisms
• Clopidogrel Metabolism and Genetic Polymorphisms
• Why Do Genetic Testing?
• Clopidogrel Genetics (Cont'd)
• Caveats — Other Reasons for Poor Response to Clopidogrel
• CYP2C19 Polymorphism May Require Another Factor
• Controversy for Clopidogrel
• Warning: Diminished Effectiveness In Poor Metabolizers
• What Does Warning Mean For Clinicians With Patients On Clopidogrel?
• FDA Answer
• More Questions
• Summary
• References
• Questions?
• Disclosure