Rabin Niroula & Lovely Chhabra
St. Vincent Hospital, USA
Niroula graduated from Sher-e-Bangla medical college, Bangladesh in 2005 and then joined residency at Saint Vincent Hospital (SVH), University of Massachusetts Medical School (UMMS) in 2009. He received his MD degree in 2012 and is currently working as a Chief Medical Resident at SVH, UMMS. His research interest is in antiplatelet therapy. He will be joining his Hematology-Oncology fellowship training at Roger Williams Medical Center, Boston University, in July, 2013 and will continue his research activities in the fi eld of Hematology-Oncology.
Introduction: Regular monitoring of platelet function in patients on antiplatelet therapy with a history of ischemic heart disease remains a clinical dilemma. Commonly used platelet function assays such as the VerifyNow P2Y12 ADP test primarily rely on a highly-specifi c reagent formulation using ADP, PGE1 and fi brinogen coated beads. Th is approach can monitor the pharmacodynamics of P2Y12 platelet receptor inhibitors, but these measurements do not accurately predict the adverse clinical outcomes related to platelet dysfunction, mainly recurrent thrombosis. In our current single-center, prospective study, we used a novel technology to monitor platelet function using a portable T2 Magnetic Resonance (T2MR) device, T2Stat, utilizing small volume blood samples and a reagent cocktail that measures ADP induced platelet mediated clot contraction. Materials and Methods: In our current investigation, we measured prospectively P2Y12 activity (using VerifyNow assay) and T2MR activity on a set of 30 samples of patients who underwent Plavix response testing. Th e T2MR reagent formulation was designed to activate platelets by ADP without PGE1 and simultaneously induce fi brin polymerization. Platelet activity was measured by T2MR via platelet-mediated clot contraction. We used this preliminary data fi rst to build a correlation between these two methodologies. We then compared short-term clinical outcomes with the P2Y12 and T2MR data obtained on an additional 22 patient samples, focusing on the 12 patient samples in which the two diagnostic tests diff ered. Results: Of 12 patients with discrepant results between two methods, 8 had available meaningful data on short-term clinical outcomes. In all of these 8 patients, we observed that the T2MR activity correlated best with the observed clinical outcomes. Conclusion: Th ese initial clinical results suggest that the T2MR ADP test has excellent potential to predict the hemostatic state of ADP-induced platelet activity in patients with history of ischemic heart disease. Additional studies will provide further evidence of the potential role of this new technology for the accurate prediction of clinical outcomes.