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CRITICAL CARE AND TRAUMA

A Novel Method to Assess Platelet Inhibition by Eptifibatide with Thrombelastograph®

Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Address correspondence and reprint requests to Kenichi A. Tanaka, MD, Department of Anesthesiology, Emory University Hospital, 1364 Clifton Rd., N.E., Atlanta, GA 30322. Address e-mail to kenichi_tanaka{at}emoryhealthcare.org

We examined a novel method to detect platelet inhibition with thrombelastography (TEG®). We hypothesized that this method would be suitable for monitoring the antiplatelet effects of eptifibatide (Integrilin®). Whole blood from healthy volunteers was anticoagulated with 3.2% citrate or unfractionated heparin (7 IU/mL). For the platelet aggregation test, both citrate and heparinized samples were spiked with increasing concentrations of eptifibatide (0, 0.2, 0.4, 0.8, 1.6, and 4 µg/mL). Conventional kaolin TEG® was performed with citrated samples, and batroxobin-modified TEG® was performed with heparinized samples, which were spiked with eptifibatide at concentrations of 0, 0.4, 0.8, 1.6, 4, 8, and 24 µg/mL. Adenosine 5'-diphosphate-induced platelet aggregation was reduced to 6.4% ± 2.9% (citrate) and 10.3% ± 4.8% (heparin) with eptifibatide at the concentration of 4 µg/mL. The kaolin TEG® showed a decrease in maximum amplitude (MA) only at the eptifibatide concentration of 24 µg/mL and no change in angle, whereas with the batroxobin-based TEG®, the difference in MA and angle was observed at concentrations 0.8 µg/mL. Additionally, the time to achieve maximum MA was much shorter for batroxobin TEG® than for kaolin TEG®. We conclude that the batroxobin-modified TEG® is a sensitive method that detects platelet inhibition induced by eptifibatide.

IMPLICATIONS: We examined a novel batroxobin-based activator for detecting platelet inhibition induced by eptifibatide on thrombelastography (TEG®). We concluded that batroxobin-modified TEG® was more sensitive than kaolin TEG® for detecting eptifibatide-induced platelet inhibition at clinical concentrations.

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				R. C. Carroll, J. J. Chavez, J. W. Simmons, C. C. Snider, D. C. Wortham, S. J. Bresee, and E. Cohen Measurement of patients' bivalirudin plasma levels by a thrombelastograph(r) ecarin clotting time assay: a comparison to a standard activated clotting time. Anesth. Analg., May 1, 2006; 102(5): 1316 - 1319. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999