Platelet function testing in clinical diagnostics

Summary

Although the utility of platelet function testing is still under debate, the necessity to inhibit platelets in patients suffering from cardiovascular and cerebrovascular disease is undoubted and well proven. The wide variety of available platelet function tests often using different methodologies, the apparent lack of standardization, and finally the emerging evidence on the clinical value of platelet function testing are resulting in a considerable uncertainty in the clinical practice, how to deal with the issue of platelet function testing. Platelet function testing might not only yield clinical benefits for the patients but also economical advantages by identifying the right drug at the right dose for the right patient.

This article intends to provide an overview of the current platelet function tests such as light transmittance aggregometry, whole blood impedance aggregometry, the PFA-100¹ system, the VerifyNow² system, flow cytometry, as well as other promising technologies like Plateletworks³, IMPACT-R⁴, PADA, thromboelastography, and the mean platelet component (MPC), briefly addressing strengths, weaknesses and clinical utility of these tests.

Zusammenfassung

Auch wenn die Nützlichkeit von Thrombozytenfunktionsuntersuchungen weiterhin debattiert wird, ist die Notwendigkeit der Thrombozyteninhibierung bei Patienten, die an kardio- und/ oder zerebrovaskulären Erkrankungen leiden, unzweifelhaft und eindeutig nachgewiesen. Die große Variabilität der erhältlichen Thrombozytenfunktionstests, die oft unterschiedliche Methodologien verwenden, das offensichtliche Fehlen von Standardisierung und letztlich der aufkommende Beweis für den klinischen Wert von Thrombozytenfunktionsuntersuchungen führen zu einer gewissen Unsicherheit in der klinischen Praxis, wie mit dem Thema Thrombozytenfunktionsuntersuchungen umgegangen werden soll. Durch die Identifikation des richtigen antithrombotischen Medikaments in der richtigen Dosis für den richtigen Patienten könnten Thrombozytenfunktionsuntersuchungen nicht nur einen klinischen, sondern auch ökonomischen Gewinn erbringen.

Dieser Artikel soll einen Überblick über Thrombozytenfunktionstests Lichttransmissionsaggregometrie, Vollblutimpedanzaggrego- metrie, PFA-100-System¹, VerifyNow-System², Durchflusszytometrie, aber auch andere vielsprechende Technologien wie Plateletworks³, IMPACT-R⁴, PADA, Thromboelasto- graphie und die Thrombozytendichte (MPC), bieten. Stärken, Schwächen und klinische Nützlichkeit der Tests werden kurz beschrieben.

Keywords

Platelet function testing - clinical application - anti-platelet drugs - bleeding risk assessment

Schlüsselwörter

Thrombozytenfunktion - klinische Anwendung - Antithrombotika - Blutungsrisiko

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