PMID- 23306859
OWN - NLM
STAT- MEDLINE
DCOM- 20130918
LR  - 20181202
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 109
IP  - 3
DP  - 2013 Mar
TI  - Hirudin anticoagulation allows more rapid determination of P2Y(1)(2) inhibition by 
      the VerifyNow P2Y12 assay.
PG  - 550-5
LID - 10.1160/TH12-10-0718 [doi]
AB  - 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 P2Y(1)(2) 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 P2Y(1)(2) 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.
FAU - Sumaya, Wael
AU  - Sumaya W
AD  - 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
FAU - Daly, Rebecca L
AU  - Daly RL
FAU - Mehra, Sonal
AU  - Mehra S
FAU - Dhutia, Amrita J
AU  - Dhutia AJ
FAU - Howgego, Kate E
AU  - Howgego KE
FAU - Ecob, Rosemary
AU  - Ecob R
FAU - Judge, Heather M
AU  - Judge HM
FAU - Morton, Allison C
AU  - Morton AC
FAU - Storey, Robert F
AU  - Storey RF
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130110
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Cations)
RN  - 0 (Citrates)
RN  - 0 (Hirudins)
RN  - 0 (P2RY12 protein, human)
RN  - 0 (Piperazines)
RN  - 0 (Receptors, Purinergic P2Y12)
RN  - 0 (Thiophenes)
RN  - 1Q73Q2JULR (Sodium Citrate)
RN  - A74586SNO7 (Clopidogrel)
RN  - G89JQ59I13 (Prasugrel Hydrochloride)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Acute Coronary Syndrome/blood
MH  - Aged
MH  - Anticoagulants/*pharmacology
MH  - Antithrombins/pharmacology
MH  - Area Under Curve
MH  - Cations
MH  - Citrates/*pharmacology
MH  - Clopidogrel
MH  - Coronary Angiography/methods
MH  - Female
MH  - Hematologic Tests/*methods
MH  - Hirudins/*pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood
MH  - Piperazines/pharmacology
MH  - Platelet Function Tests/methods
MH  - Prasugrel Hydrochloride
MH  - Receptors, Purinergic P2Y12/analysis/*metabolism
MH  - Sodium Citrate
MH  - Thiophenes/pharmacology
MH  - Ticlopidine/analogs & derivatives/pharmacology
MH  - Treatment Outcome
EDAT- 2013/01/12 06:00
MHDA- 2013/09/21 06:00
CRDT- 2013/01/12 06:00
PHST- 2012/10/02 00:00 [received]
PHST- 2012/12/07 00:00 [accepted]
PHST- 2013/01/12 06:00 [entrez]
PHST- 2013/01/12 06:00 [pubmed]
PHST- 2013/09/21 06:00 [medline]
AID - 12-10-0718 [pii]
AID - 10.1160/TH12-10-0718 [doi]
PST - ppublish
SO  - Thromb Haemost. 2013 Mar;109(3):550-5. doi: 10.1160/TH12-10-0718. Epub 2013 Jan 
      10.