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Research ArticleINTERVENTIONAL

Clopidogrel Resistance in Neurovascular Stenting: Correlations between Light Transmission Aggregometry, VerifyNow, and the Multiplate

N. Flechtenmacher, F. Kämmerer, R. Dittmer, U. Budde, P. Michels, J. Röther and B. Eckert
American Journal of Neuroradiology October 2015, 36 (10) 1953-1958; DOI: https://doi.org/10.3174/ajnr.A4388
N. Flechtenmacher
aFrom the Departments of Neuroradiology (N.F., F.K., B.E.)
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F. Kämmerer
aFrom the Departments of Neuroradiology (N.F., F.K., B.E.)
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R. Dittmer
cDepartment of Laboratory Medicine (R.D., U.B.), Medilys Laboratory Company, Hamburg, Germany.
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U. Budde
cDepartment of Laboratory Medicine (R.D., U.B.), Medilys Laboratory Company, Hamburg, Germany.
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P. Michels
bNeurology (P.M., J.R.), Asklepios Klinik Altona, Hamburg, Germany
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J. Röther
bNeurology (P.M., J.R.), Asklepios Klinik Altona, Hamburg, Germany
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B. Eckert
aFrom the Departments of Neuroradiology (N.F., F.K., B.E.)
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  • Fig 1.
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    Fig 1.

    Individual test results of VerifyNow (A), the Multiplate (B), and LTA (C). The line parallel to the x-axis marks the particular cutoff value that has been used to discriminate between clopidogrel resistance and clopidogrel response. Procedures in which an embolic complication occurred are indicated by plus signs. Embolic complications Nr.53 and Nr.54 occurred in a single patient with 2 subsequent treatments of a symptomatic ICA and vertebral artery stenosis, respectively. PRU indicates P2Y12 reaction units; MA, maximal aggregation; AUC, area under the curve.

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    Fig 2.

    Correlation scatterplots of individual results obtained with VerifyNow versus the Multiplate (A), the Multiplate versus LTA (B), and VerifyNow versus LTA (C). Lines parallel to the axes mark the particular cutoff values. The upper-right and lower-left quadrants contain values with agreement in regard to the definition of clopidogrel resistance. Procedures in which an embolic complication occurred are indicated by plus signs.

Tables

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    Table 1:

    Incidence of clopidogrel resistance

    Clopidogrel Statusn%
    Resistant according to:
        ≥1 method6967
        ≥2 methods4341.9
        All 3 methods2423.3
    Clopidogrel responsive according to all 3 methods3433
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    Table 2:

    Correlation of clopidogrel test results and thromboembolic events

    MethodTotal (n)No Complications (n [%])Thromboembolic Complication (n [%])P Value
    VerifyNow
        Resistant524688.4611.5.6413
        Responsive514894.135.9
    Multiplate
        Resistant353188.6411.4.5816
        Responsive686392.757.5
    LTA
        Resistant494285.7714.3.0938
        Responsive545296.323.7
    • View popup
    Table 3:

    Relationship of clopidogrel resistance and thromboembolic complications

    MethodSensitivity (%)Specificity (%)Positive Predictive Value (%)Negative Predictive Value (%)
    VerifyNow66.751.111.594.1
    Multiplate44.467.011.492.7
    LTA77.855.314.396.3
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American Journal of Neuroradiology: 36 (10)
American Journal of Neuroradiology
Vol. 36, Issue 10
1 Oct 2015
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Cite this article
N. Flechtenmacher, F. Kämmerer, R. Dittmer, U. Budde, P. Michels, J. Röther, B. Eckert
Clopidogrel Resistance in Neurovascular Stenting: Correlations between Light Transmission Aggregometry, VerifyNow, and the Multiplate
American Journal of Neuroradiology Oct 2015, 36 (10) 1953-1958; DOI: 10.3174/ajnr.A4388

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Clopidogrel Resistance in Neurovascular Stenting: Correlations between Light Transmission Aggregometry, VerifyNow, and the Multiplate
N. Flechtenmacher, F. Kämmerer, R. Dittmer, U. Budde, P. Michels, J. Röther, B. Eckert
American Journal of Neuroradiology Oct 2015, 36 (10) 1953-1958; DOI: 10.3174/ajnr.A4388
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