Failure of the Platelet Function Assay (PFA)-100 to detect antiplatelet agents

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• 作者：Ashley Bartels ; MD ; ^{bartelsan@health.missouri.edu" class="auth_mail" title="E-mail the corresponding author} ; Yaw Sarpong ; MD ; Jared Coberly ; MD ; Natalie Hughes ; BS ; Jeffrey Litt ; DO ; Jacob Quick ; MD ; James Kessel ; MD ; Christopher Nelson ; MD ; Jeffery Coughenour ; MD ; Stephen L. Barnes ; MD ; N. Scott Litofsky ; MD ; Richard D. Hammer ; MD ; Salman Ahmad ; MD
• 刊名：Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：158
• 期：4
• 页码：1012-1019
• 全文大小：181 K

文摘

Antiplatelet therapy is a complicating factor in patients with traumatic brain injuries (TBI), as well as those with hemorrhagic cerebrovascular accidents (CVAs). Platelet Function Assay (PFA)-100 is a coagulation device that can detect platelet dysfunction caused by aspirin and adenosine diphosphate inhibition. Our retrospective study reviewed the effectiveness of PFA-100 in detecting platelet dysfunction caused by aspirin and clopidogrel and determined its clinical importance.

Methods

All patients with PFA-100 tests from January 2013 to February 2014 were collected. Diagnoses indicative of a TBI or CVA were chosen for analysis. Patients with a normal PFA-100 indicating no platelet dysfunction but with documented aspirin and/or clopidogrel use were selected. An extensive chart review was performed to determine the relevance to their clinical care.

Results

A total of 475 patients were evaluated with a PFA-100 from January 2013 to February 2014. PFA-100 detected platelet dysfunction as the result of pre-injury use of antiplatelet agents in TBI and CVA patients with a sensitivity of only 48.6% and a specificity of 74.8%. Had these antiplatelet medications been known during initial workup, these patients would have had a change in management that may have impacted their outcomes.

Conclusion

Despite its common usage, the PFA-100 is an unreliable tool to assist in the management of TBI and CVA patients. Additional investigation into alternative methods for detecting platelet dysfunction is warranted.