Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2022, 31(4):221-228

The role of thromboelastometry in monitoring the response to antiplatelet therapy: our experiences and review of literature

Samos M1, Simonova R2, Bolek T1, Skornova I2, Stanciakova L2, Stasko J2, Mokan M1
1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
2 National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic

Aim: Insufficient response to antiplatelet therapy, so called high on-treatment platelet reactivity (HTPR), has been repeatedly associated with increased risk of adverse ischemic events. Rotational thromboelastometry (ROTEM®) is a novel viscoelastic hemostatic assay which could, in theory, overcome some limitations of currently available platelet function testing assays. The aim of the article is to report our experiences with the use of ROTEM® for assessment of HTPR in patients with acute myocardial infarction (MI) and review the current experience with the use of the assay for platelet function testing and for monitoring of the response to antiplatelet therapy.

Methods: A pilot prospective study assessing the use of ROTEM® in monitoring the antiplatelet therapy in consecutively enrolled patients with acute MI was performed. In addition, a narrative review of current knowledge about the use of the assay for identifying HTPR is given.

Results: Patients with MI showed decreased platelet aggregation after the use of specific inducers. The ROTEM® analysis showed significant differences in clotting time for EXTEM® and FIBTEM® test and in maximum clot firmness for FIBTEM® comparing MI patients with controls. No significant differences in other variables were found.

Conclusion: Up to date, there is no study demonstrating the ability of ROTEM® to monitor the treatment response to antiplatelet drugs or to search for patients with HTPR.

Keywords: rotation thromboelastometry; ROTEM®; antiplatelet therapy; acute coronary syndrome

Published: April 1, 2022  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Samos M, Simonova R, Bolek T, Skornova I, Stanciakova L, Stasko J, Mokan M. The role of thromboelastometry in monitoring the response to antiplatelet therapy: our experiences and review of literature. Cardiology Letters. 2022;31(4):221-228.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Sibbing D, Byrne RA, Kastrati A. Role of platelet function testing in clinical practice: current concepts and future perspectives. Curr Drug Targets 2011;12:1836-1847. Go to original source...
    2. Gross L, Aradi D, Sibbing D. Platelet Function Testing in Patients on Antiplatelet Medications. Semin Thromb Hemost 2016;42:306320. Go to original source...
    3. Janssen PW, ten Berg JM. Platelet function testing and tailored antiplatelet therapy. J Cardiovasc Transl Res 2013;6:316-328. Go to original source...
    4. Korpallová B, Samoš M, Bolek T, Škorňová I, Kovář F, Kubisz P, et al. Role of Thromboelastography and Rotational Thromboelastometry in the Management of Cardiovascular Diseases. Clin Appl Thromb Hemost 2018;24:1199-207. Go to original source...
    5. Larsen JB, Hvas AM. Predictive Value of Whole Blood and Plasma Coagulation Tests for Intra- and Postoperative Bleeding Risk: A Systematic Review. Semin Thromb Hemost 2017;43:772805. Go to original source...
    6. Durila M, Malošek M. Rotational thromboelastometry along with thromboelastography plays a critical role in the management of traumatic bleeding. Am J Emerg Med 2014;32:288.e1-3. Go to original source...
    7. McCrossin KE, Bramley DE, Hessian E, Hutcheon E, Imberger G. Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis - a protocol. Syst Rev 2016;5:151. Go to original source...
    8. Li C, Zhao Q, Yang K, Jiang L, Yu J. Thromboelastography or rotational thromboelastometry for bleeding management in adults undergoing cardiac surgery: a systematic review with meta-analysis and trial sequential analysis. J Thorac Dis 2019;11:1170-81. Go to original source...
    9. Marcucci R, Gori AM, Paniccia R, Giusti B, Valente S, Giglioli C, et al. Cardiovascular death and nonfatal myocardial infarction in acute coronary syndrome patients receiving coronary stenting are predicted by residual platelet reactivity to ADP detected by a point-of-care assay: a 12-month follow-up. Circulation 2009;119:237-242. Go to original source...
    10. Viviani Anselmi C, Briguori C, Roncarati R, Papa L, Visconti G, Focaccio A. Routine assessment of on-clopidogrel platelet reactivity and gene polymorphisms in predicting clinical outcome following drug-eluting stent implantation in patients with stable coronary artery disease. JACC Cardiovasc Interv 2013;6:11661175. Go to original source...
    11. Gianetti J, Parri MS, Sbrana S, Paoli F, Maffei S, Paradossi U, et al. Platelet activation predicts recurrent ischemic events after percutaneous coronary angioplasty: a 6 months prospective study. Thromb Res 2006;118:487-493. Go to original source...
    12. Price MJ, Berger PB, Angiolillo DJ, Teirstein PS, Tanguay JF, Kandzari DE, et al Evaluation of individualized clopidogrel therapy after drug-eluting stent implantation in patients with high residual platelet reactivity: design and rationale of the GRAVITAS trial. Am Heart J 2009;157:818-824. Go to original source...
    13. Li X, Wang Z, Wang Q, Xu Q, Lv Q. Clopidogrel-associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients. Basic Clin Pharmacol Toxicol 2019;124:84-93. Go to original source...
    14. Aradi D, Gross L, Trenk D, Geisler T, Merkely B, Kiss RG, et al. Platelet reactivity and clinical outcomes in acute coronary syndrome patients treated with prasugrel and clopidogrel: a pre-specified exploratory analysis from the TROPICAL-ACS trial. Eur Heart J 2019;40:1942-1951. Go to original source...
    15. Sato T, Namba Y, Kashihara Y, Tanaka M, Fuke S, Yumoto A, et al. Clinical significance of platelet reactivity during prasugrel therapy in patients with acute myocardial infarction. J Cardiol 2017;70:35-40. Go to original source...
    16. Jariwala P, Bhatia H, Kumar EAP. Sub-acute stent thrombosis secondary to ticagrelor resistance - Myth or reality!! Indian Heart J 2017 69:804-806. Go to original source...
    17. Samoš M, Stančiaková L, Duraj L, Kovář F, Fedor M, Šimonová R, et al. Monitoring the hemostasis with rotation thromboelastometry in patients with acute STEMI on dual antiplatelet therapy: First experiences. Medicine (Baltimore) 2017;96:e6045. Go to original source...
    18. Scharbert G, Auer A, Kozek-Langenecker S. Evaluation of the Platelet Mapping Assay on rotational thromboelastometry ROTEM. Platelets 2009;20:125-130. Go to original source...
    19. Braun D, Knipper A, Orban M, Sibbing D, Petzold T, Braun S, et al. Platelet function and coagulation in patients with STEMI and peri-interventional clopidogrel plus heparin vs. prasugrel plus bivalirudin therapy (BRAVE 4 substudy). Thromb Res 2016;137:72-78. Go to original source...
    20. Ogawa S, Szlam F, Chen EP, Nishimura T, Kim H, Roback JD, et al. A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution-induced coagulation changes after cardiac surgery. Transfusion 2012;52:14-22. Go to original source...
    21. Tarzia V, Bortolussi G, Buratto E, Paolini C, Dal Lin C, Rizzoli G, et al. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting. World J Cardiol 2015;7:571-578. Go to original source...
    22. Azarfarin R, Noohi F, Kiavar M, Totonchi Z, Heidarpour A, Hendiani A, et al. Relationship between maximum clot firmness in ROTEM() and postoperative bleeding after coronary artery bypass graft surgery in patients using clopidogrel. Ann Card Anaesth 2018;21:175-180. Go to original source...

    Return to the content