Comparative study of four platelet function tests conducted using two systems in neuroendovascular patients

Confirming the antiplatelet effects of P2Y12 inhibitors is clinically important; although various methods exist for evaluating such antiplatelet effects, standard protocols are currently unavailable. We compared four platelet function tests in neuroendovascular patients performed based on two systems: (i) ADP-induced platelet aggregation level (APAL) and (ii) 10 µM ADP maximum aggregation (MA) using CN-6000, and (iii) P2Y12 reaction unit (PRU) as well as (iv) %inhibition using VerifyNow. Retrospective data of all 124 patients (median age 72 [26-92] years; 58.9% male) who received periprocedural antiplatelet therapy for elective neuroendovascular treatments between September 2020-December 2023 were evaluated. Blood samples were acquired the day before, immediately (1-3 days), and 1 month postoperatively, and during bleeding or thrombotic events. The results revealed changes over time in PRU, %inhibition, and APAL values, but not in 10 µM ADP MA. The correlation coefficient for PRU, the most widely used test in this setting, was higher with APAL (r = 0.55, p < 0.01) than with 10 µM ADP MA (r = 0.42, p < 0.01). An APAL result of 8.3 was equivalent to a PRU value of 240. In conclusion, APAL may provide more reliable monitoring of antiplatelet effects than 10 µM ADP MA-based monitoring and is worthy of further evaluation.