Vasodilator-stimulated phosphoprotein-phosphorylation assay in patients on clopidogrel: does standardisation matter?

Thromb Haemost. 2012 Mar;107(3):538-44. doi: 10.1160/TH11-09-0623. Epub 2012 Jan 25.

Abstract

The vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) flow-cytometric assay is mainly used in clinical trials to measure thienopyridine effects. However, there are remarkable differences in the reported optimal cut-offs, ranging from 48-61% platelet reactivity index (PRI). We therefore investigated whether a lack of standardisation might explain the differences in the cut-offs. We measured VASP-P in 62 individuals. PRI was calculated using the mean, geometric mean and median fluorescence intensities (FI). Stability of the blood-samples (time-to-assay, 0-2 days) and stability of the processed samples (0-120 minutes) within the recommended time-span were tested. Time-to-assay significantly influenced the PRI (p<0.001): the PRI from mean FI after two days was lower compared to values on day 1 (52 ± 22.9 vs. 57.7 ± 24.1, p<0.001). The PRI from the geometric mean FI after two days was lower compared to day 0 as well as day 1 (51.3 ± 23 vs. 58.2 ± 24.2 and vs. 59.1 ± 23.7, both p<0.001). The PRI from median FI was stable over time (day 0: 59.1 ± 25%, day 1: 59.7 ± 24.1% and day 2: 56.4 ± 23.9%, all p=ns). Furthermore, the lag time of the processed samples significantly altered the PRI (all p<0.001) with a maximum difference for PRI based on geometric mean FI after 90 minutes compared to baseline (Δ=3.92%PRI, p<0.001). The differences in the reported cut-offs might be explained by a lack of standardisation. More precise standardisation is inevitable, as the PRI significantly depends on the method of calculation, the time-to-assay as well as on the lag time after processing. Tolerably stable results were obtained for the PRI from the median FI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Specimen Collection / standards
  • Blood Specimen Collection / statistics & numerical data
  • Cell Adhesion Molecules / metabolism*
  • Cell Separation
  • Clopidogrel
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / epidemiology*
  • Flow Cytometry
  • Humans
  • Microfilament Proteins / metabolism*
  • Observer Variation
  • Phosphoproteins / metabolism*
  • Phosphorylation / drug effects
  • Platelet Activation / drug effects
  • Platelet Function Tests / methods
  • Platelet Function Tests / standards*
  • Platelet Function Tests / statistics & numerical data
  • Prospective Studies
  • Reference Standards
  • Ticlopidine / administration & dosage
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives*
  • Vasodilator Agents / metabolism

Substances

  • Cell Adhesion Molecules
  • Microfilament Proteins
  • Phosphoproteins
  • Vasodilator Agents
  • vasodilator-stimulated phosphoprotein
  • Clopidogrel
  • Ticlopidine