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Liu Z, Huang X, Gao X, Zhang T, He C, Ding L, Li Y. Antiplatelet Agents Inhibit Platelet Adhesion and Aggregation on Glass Surface Under Physiological Flow Conditions: Toward a Microfluidic Platelet Functional Assay Without Additional Adhesion Protein Modification. J Cardiovasc Pharmacol 2024; 83:173-182. [PMID: 38032897 DOI: 10.1097/fjc.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
ABSTRACT As the pathogenesis of arterial thrombosis often includes platelet adhesion and aggregation, antiplatelet agents are commonly used to prevent thromboembolic events. Here, a new microfluidic method without additional adhesion protein modification was developed to quantify the inhibitory effect of antiplatelet drugs on the adhesion and aggregation behavior of platelets on glass surfaces under physiological flow conditions. Polydimethylsiloxane-glass microfluidic chips were fabricated by soft photolithography. Blood samples from healthy volunteers or patients before and after taking antiplatelet drugs flowed through the microchannels at wall shear rates of 300 and 1500 second -1 , respectively. The time to reach 2.5% platelet aggregation surface coverage (Ti), surface coverage (A 150s ), and mean fluorescence intensity (F 150s ) were used as quantitative indicators. Aspirin (80 μM) prolonged Ti and reduced F 150s . Alprostadil, ticagrelor, eptifibatide, and tirofiban prolonged Ti and reduced A 150s and F 150s in a concentration-dependent manner, whereas high concentrations of alprostadil did not completely inhibit platelet aggregation. Aspirin combined with ticagrelor synergistically inhibited platelet adhesion and aggregation; GPIb-IX-von Willebrand factor inhibitors partially inhibited platelet aggregation, and the inhibition was more pronounced at 1500 than at 300 second -1 . Patient administration of aspirin or (and) clopidogrel inhibited platelet adhesion and aggregation on the glass surface under flow conditions. This technology is capable of distinguishing the pharmacological effects of various antiplatelet drugs on inhibition of platelet adhesion aggregation on glass surface under physiological flow conditions, which providing a new way to develop microfluidic platelet function detection method without additional adhesive protein modification for determining the inhibitory effects of antiplatelet drugs in the clinical setting.
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Affiliation(s)
- Zhanshu Liu
- Department of Hematology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaojing Huang
- Central Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, China; and
| | - Xuemei Gao
- Central Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, China; and
| | - Tiancong Zhang
- Central Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, China; and
| | - Cui He
- Central Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, China; and
| | - Ling Ding
- Yongchuan Sub-center, Chongqing Blood Center, Chongqing, China
| | - Yuan Li
- Central Laboratory, Yongchuan Hospital, Chongqing Medical University, Chongqing, China; and
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Aspirin Resistance in Vascular Disease: A Review Highlighting the Critical Need for Improved Point-of-Care Testing and Personalized Therapy. Int J Mol Sci 2022; 23:ijms231911317. [PMID: 36232618 PMCID: PMC9570127 DOI: 10.3390/ijms231911317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Aspirin resistance describes a phenomenon where patients receiving aspirin therapy do not respond favorably to treatment, and is categorized by continued incidence of adverse cardiovascular events and/or the lack of reduced platelet reactivity. Studies demonstrate that one in four patients with vascular disease are resistant to aspirin therapy, placing them at an almost four-fold increased risk of major adverse limb and adverse cardiovascular events. Despite the increased cardiovascular risk incurred by aspirin resistant patients, strategies to diagnose or overcome this resistance are yet to be clinically validated and integrated. Currently, five unique laboratory assays have shown promise for aspirin resistance testing: Light transmission aggregometry, Platelet Function Analyzer-100, Thromboelastography, Verify Now, and Platelet Works. Newer antiplatelet therapies such as Plavix and Ticagrelor have been tested as an alternative to overcome aspirin resistance (used both in combination with aspirin and alone) but have not proven to be superior to aspirin alone. A recent breakthrough discovery has demonstrated that rivaroxaban, an anticoagulant which functions by inhibiting active Factor X when taken in combination with aspirin, improves outcomes in patients with vascular disease. Current studies are determining how this new regime may benefit those who are considered aspirin resistant.
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Piao J, Yoo C, Kim S, Whang YW, Choi CU, Shin S. Performance comparison of the PFA-200 and Anysis-200: Assessment of bleeding risk screening in cardiology patients. Clin Hemorheol Microcirc 2021; 79:445-454. [PMID: 34657880 PMCID: PMC8764596 DOI: 10.3233/ch-211185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of platelet function is important in the management of patients who are subject to operation as well as at potential risk of hemorrhagic complications. OBJECTIVE This study aimed to evaluate a new platelet assays (Anysis-Epinephrine, Anysis-ADP) and to compare them with PFA-200 in cardiology visiting patients and inpatients. METHODS Citrated blood samples were collected from 184 patients for ADP test and 163 patients for EPI test, who visited Korea University Guro Hospital with written consent. The PFA-200 assay gives a test result the closure time (CT) until the blood flow rate decreases to 10%of the initial value, whereas Anysis-200 assay does a blood flow migration distance (MD) until blood flow completely stops. According to the results of PFA closure time (CT), the tested samples were classified as either negative control or positive group. The measurements were simultaneously conducted with two devices and compared. RESULTS The sensitivity and specificity of Anysis-200 C/EPI kit in comparison to PFA-200 C/EPI kit was 87.5%and 85.7%, respectively. Regarding C/ADP kit, the sensitivity and specificity of Anysis-200 was 96.9%and 87.5%, respectively. In addition, the sums of sensitivity and specificity are greater than 150%for both of EPI and ADP. Also, it was found that likelihood ratio and odd ratio for each assay provide useful additional information. Since the Cohen's kappa coefficients value between the two devices was relatively high, the equivalence between the two devices was confirmed. CONCLUSIONS Anysis-200, a novel platelet function analyzer has showed excellent agreements with PFA-200 with high agreement rates and precision. Anysis-200 assay would be useful in assessing bleeding risk management as well as abnormal platelet reactivity at point of care.
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Affiliation(s)
- Jinxiang Piao
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | - Chaeyoung Yoo
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | | | - Youn-Wha Whang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Cheol Ung Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sehyun Shin
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea.,School of Mechanical Engineering, Korea University, Seoul, Korea
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Khan H, Jain S, Gallant RC, Syed MH, Zamzam A, Al-Omran M, Rand ML, Ni H, Abdin R, Qadura M. Plateletworks ® as a Point-of-Care Test for ASA Non-Sensitivity. J Pers Med 2021; 11:813. [PMID: 34442457 PMCID: PMC8398990 DOI: 10.3390/jpm11080813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Aspirin (ASA) therapy is proven to be effective in preventing adverse cardiovascular events; however, up to 30% of patients are non-sensitive to their prescribed ASA dosage. In this pilot study, we demonstrated, for the first time, how ASA non-sensitivity can be diagnosed using Plateletworks®, a point-of-care platelet function test. Patients prescribed 81 mg of ASA were recruited in a series of two successive phases-a discovery phase and a validation phase. In the discovery phase, a total of 60 patients were recruited to establish a cut-off point (COP) for ASA non-sensitivity using Plateletworks®. Each sample was simultaneously cross-referenced with a light transmission aggregometer (LTA). Our findings demonstrated that >52% maximal platelet aggregation using Plateletworks® had a sensitivity, specificity, and likelihood ratio of 80%, 70%, and 2.67, respectively, in predicting ASA non-sensitivity. This COP was validated in a secondary cohort of 40 patients prescribed 81 mg of ASA using Plateletworks® and LTA. Our data demonstrated that our established COP had a 91% sensitivity and 69% specificity in identifying ASA non-sensitivity using Plateletworks®. In summary, Plateletworks® is a point-of-care platelet function test that can appropriately diagnose ASA non-sensitive patients with a sensitivity exceeding 80%.
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Affiliation(s)
- Hamzah Khan
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
| | - Shubha Jain
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
| | - Reid C. Gallant
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (R.C.G.); (H.N.)
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (R.C.G.); (H.N.)
- Department of Surgery, University of Toronto, Toronto, ON M4B 1B3, Canada
| | - Margaret L. Rand
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON M4B 1B3, Canada;
- Departments of Biochemistry and Pediatrics, University of Toronto, Toronto, ON M4B 1B3, Canada
- Translational Medicine, Research Institute, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON M4B 1B3, Canada
| | - Heyu Ni
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (R.C.G.); (H.N.)
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON M4B 1B3, Canada;
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (H.K.); (S.J.); (M.H.S.); (A.Z.); (M.A.-O.)
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M4B 1B3, Canada; (R.C.G.); (H.N.)
- Department of Surgery, University of Toronto, Toronto, ON M4B 1B3, Canada
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Piao J, Yoo C, Kim S, Whang YW, Choi CU, Shin S. Performance comparison of aspirin assay between anysis and verifynow: Assessment of therapeutic platelet inhibition in patients with cardiac diseases. Clin Hemorheol Microcirc 2021; 79:327-334. [PMID: 33967038 PMCID: PMC8673509 DOI: 10.3233/ch-211171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND: Assessment of platelet inhibition for aspirin therapy is important to manage patients who are at potential risk of developing thrombotic and hemorrhagic complications. OBJECTIVE: This study aimed to evaluate a new platelet assay (Anysis-aspirin), compare it with VerifyNow-aspirin in patients with cardiac diseases, and analyze the aspirin resistance rates between the two devices. METHODS: Citrated blood samples were collected from patients with cardiac diseases referred for the aspirin response test. In the Anysis assay, a test result was provided with a blood flow migration distance (MD) until blood flow stoppage, which was comparable to aspirin reaction units (ARUs) obtained using VerifyNow. The measurements were simultaneously conducted using the two devices and compared. RESULTS: The MD without and with aspirin use was 160±33 and 254±23 mm, respectively (p < 0.0001). Compared with VerifyNow (reference), the sensitivity and specificity of Anysis-200 were 96.3 and 90.3%, respectively (area under the curve, 0.968). Furthermore, the aspirin resistance rate in aspirin-administered patients was 20.9%using VerifyNow and 16.5%for Anysis-200. The Cohen’s kappa coefficient between the two devices was 0.81, indicating an almost perfect agreement between the two devices. CONCLUSIONS: Anysis-aspirin, a novel aspirin assay for assessing platelet inhibition, showed excellent agreement with VerifyNow-aspirin with high accuracy and precision. The Anysis-aspirin assay would be used as a point-of-care test to assess aspirin non-responsiveness and abnormal platelet reactivity.
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Affiliation(s)
- Jinxiang Piao
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | - Chaeyoung Yoo
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | | | - Youn-Wha Whang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Cheol Ung Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sehyun Shin
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea.,School of Mechanical Engineering, Korea University, Seoul, Korea
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Piao J, Yoo C, Kim S, Whang YW, Shin S, Choi CU. Assessment of therapeutic platelet inhibition in cardiac patients: Comparative study between VerifyNow-P2Y12 and Anysis-P2Y12 assay. Clin Hemorheol Microcirc 2021; 78:439-448. [PMID: 33867355 DOI: 10.3233/ch-211104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Analyzing responsiveness to P2Y12 therapy is vital to preventing thrombotic and hemorrhagic complications in patients with cardiovascular diseases. OBJECTIVE This study evaluates a new Anysis-P2Y12 assay system against VerifyNow-P2Y12 in cardiac patients and analyzes the P2Y12 low-response rates of the two devices with various cutoff values. METHODS In total, 125 citrated blood samples were collected from cardiac patients referred for a P2Y12 antiplatelet response test. In the Anysis assay, the test result was the migration distance (MD) until the blood flow stops, which is comparable to both P2Y12 reaction units and percent inhibition obtained using VerifyNow. RESULTS The MDs without and with P2Y12 were 182±30 and 264±12 mm, respectively (p < 0.0001). Compared to VerifyNow-P2Y12, the sensitivity and specificity of Anysis-200 were 96.8%and 88.7%, respectively. Cohen's kappa coefficient between the two devices was 0.761, indicating a high agreement. However, there was an apparent difference in the low-response rate to P2Y12, which was 36.5%for VerifyNow and 5.9%for Anysis. CONCLUSIONS The performance of the newly developed platelet function assay, Anysis-P2Y12 was equivalent to that of VerifyNow-P2Y12 in terms of sensitivity and specificity. The Anysis-P2Y12 assay may help screen patients with abnormal P2Y12 non-responsiveness.
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Affiliation(s)
- Jinxiang Piao
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | - Chaeyoung Yoo
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea
| | | | - Youn-Wha Whang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sehyun Shin
- Engineering Research Center for Biofluid Biopsy, Korea University, Seoul, Korea.,School of Mechanical Engineering, Korea University, Seoul, Korea
| | - Cheol Ung Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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