title: Hirudin anticoagulation allows more rapid determination of P2Y₁₂ inhibition by the VerifyNow P2Y12 assay.
abstract: VerifyNow (VN) P2Y12 is a point-of-care assay used to assess response to P2Y12 inhibitors. Sodium citrate (citrate) is the standard anticoagulant used for this assay but requires a pre-incubation period. Hirudin is an alternative anticoagulant for platelet function studies that maintains physiological divalent cation levels. We investigated whether hirudin anticoagulation might allow more rapid testing of P2Y₁₂ inhibition at the time of percutaneous coronary intervention (PCI). Blood was collected from the arterial sheath of aspirin-treated patients undergoing elective, urgent or emergency coronary angiography±PCI and aliquots were anticoagulated with either citrate or hirudin. For each anticoagulant, VN P2Y12 was performed both immediately and after 20 minutes. A total of 98 patients were included in this study following pre-treatment with clopidogrel (n=88), prasugrel (n=6) or no P2Y₁₂ inhibitor (n=4). PRU with hirudin immediately (PRU_H_Imm) and PRU with citrate 20 minutes post sampling (PRU_C_20) were very strongly correlated (R=0.95) though PRU_H_Imm tended to be lower than PRU_C_20 so that optimal correlation was estimated by the equation PRU_H_Imm=0.95xPRU_C_20 (p<0.001). Bland-Altman plots showed good agreement between PRU_H_Imm and (0.95xPRU_C_20). Platelet reactivity was more stable over the studied time course with hirudin as compared to citrate. We therefore conclude that VN P2Y12 with hirudin anticoagulation can be performed more rapidly and results are strongly correlated with delayed citrate measurements. Further studies are warranted to assess the utility of this method for improving clinical outcomes in patients undergoing PCI.
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Centre for Biomedical Research, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. w.sumaya@sheffield.ac.uk
authors.forename: Wael
authors.initials: W
authors.lastname: Sumaya
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Daly
authors.forename: Sonal
authors.initials: S
authors.lastname: Mehra
authors.forename: Amrita J
authors.initials: AJ
authors.lastname: Dhutia
authors.forename: Kate E
authors.initials: KE
authors.lastname: Howgego
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ecob
authors.forename: Heather M
authors.initials: HM
authors.lastname: Judge
authors.forename: Allison C
authors.initials: AC
authors.lastname: Morton
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D000991:Antithrombins / Q000494:pharmacology; D019540:Area Under Curve; D002412:Cations; D002951:Citrates / Q000494:pharmacology*; D000077144:Clopidogrel; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006403:Hematologic Tests / Q000379:methods*; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D010879:Piperazines / Q000494:pharmacology; D010979:Platelet Function Tests / Q000379:methods; D000068799:Prasugrel Hydrochloride; D058925:Receptors, Purinergic P2Y12 / Q000032:analysis / Q000378:metabolism*; D000077559:Sodium Citrate; D013876:Thiophenes / Q000494:pharmacology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D002412:Cations; D002951:Citrates; D006629:Hirudins; C548576:P2RY12 protein, human; D010879:Piperazines; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000077559:Sodium Citrate; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine