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Thromb Haemost 2013; 110(05): 1055-1064
DOI: 10.1160/TH13-03-0203
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Identification of poor response to P2Y12 inhibitors in ACS patients with a new ELISA-based vasodilator-associated stimulated phosphoprotein (VASP) phosphorylation assay

Jérémie Abtan
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Johanne Silvain
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Mathieu Kerneis
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Stephen A. O’Connor
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Olivier Barthélémy
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Jean-Baptiste Vignalou
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Farzin Beygui
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Delphine Brugier
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Jean-Philippe Collet
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
,
Gilles Montalescot
1   Institut de Cardiologie, INSERM UMRS937, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6 (UPMC), Paris, France
› Author Affiliations Financial support: This study was conducted and supported by the ACTION (Allies in Cardiovascular Trials Initiatives and Organized Networks) Group (www.action-coeur.org). Technical support was provided by Biocytex (Marseille, France) and Stago (Asnières-sur-Seine, France).
Further Information

Publication History

Received: 07 March 2013

Accepted after major revision: 07 July 2013

Publication Date:
01 December 2017 (online)

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Summary

A new ELISA technique has been developed to measure the vasodilator-associated stimulated phosphoprotein (VASP) platelet reactivity index (PRI) in clopidogrel-treated patients. This technique has not been evaluated in acute coronary syndrome (ACS) patients or in prasugrel-treated patients. We assessed the accuracy of ELISA-VASP to identify high on-treatment platelet reactivity (HPR) in ACS patients in comparison with established platelet function tests. Platelet reactivity was measured in 240 ACS patients treated with clopidogrel (75 or 150 mg) or prasugrel (5 or 10 mg) using flow cytometry (FC-VASP) and the ELISA-VASP technique, light transmission aggregometry (LTA) and VerifyNow-P2Y12 assay (VN-P2Y12). When using the ELISA-VASP PRI, the rate of patients with HPR in the overall ACS population was 15.5%, including a 27% rate in clopidogrel-treated patients and a 4% rate in prasugrel-treated patients. There was a strong correlation between ELISA-VASP PRI and FC-VASP PRI (r = 0.83, r2 = 0.68 p < 0.0001) with an area under the receiver-operating characteristics (ROC) curve to identify HPR (VASP-PRI >50% with FC-VASP) of 0.94, p<0.0001. The threshold of 60% for ELISA-VASP PRI provided the best accuracy (likelihood ratio= 23.67) to identify patients with HPR when compared to FC-VASP, LTA or VN-P2Y12 assays. In conclusion, ELISA-VASP is a fast, easy-to-use and specific test to identify HPR in ACS patients on thienopyridines. A 60% threshold value displays the best accuracy to identify HPR in these patients.

Keywords

VASP - ELISA - flow cytometry - platelet reactivity - ACS
 

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