Table 3.
Performance of thromboelastography with PlateletMapping® assay vs. the current gold-standard assay in studies in China (LTA) [8,25,27,29,31].
| Study | Drug Intake and Timing of Assay Utilization | TEG® Device Used | Between-Parameter Correlations |
Identification of HTPR | Prediction of MACE/Ischemic Risk | Summary | |
|---|---|---|---|---|---|---|---|
| Thromboelastography | LTA | ||||||
| Tang, X F et al. (2015) [24] N = 789 |
Loading doses (12 h prior to PCI)—therapy-naïve patients: 300 mg DAPT; patients previously on antiplatelet therapy: 100 mg aspirin, 75 mg clopidogrel Daily maintenance dose following surgery: 100 mg aspirin, 75 mg clopidogrel TEG® assay carried out 6 h after clopidogrel dose |
TEG®5000 | Spearman coefficient for ADP.%inhibition vs. ARADP.LTA: r = 0.733, p < 0.001 |
HTPR cutoff for ADP.%inhibition (≤32%) found in 36.1% of enrolled subjects HTPR cutoff for ARADP.LTA: (53.2%) found in 29% of subjects |
ROC curve analysis AUC, % (95% CI) = 0.684 (0.650–0.716), 0.0001 1-year MACE occurred in 6.7% with and 2.6% without HTPR |
ROC curve analysis AUC, % (95% CI) = 0.677 (0.643–0.710), p = 0.0009 1-year MACE occurred in 7.4% and 2.7% without HTPR |
Thromboelastography has shown strong performance for detecting low DAPT response/HTPR, with a high sensitivity and specificity for detecting HTPR (similar to LTA); Thromboelastography has also shown comparable performance to LTA in predicting ischemic risk at 6 months and 1 year; The strength of correlations between thromboelastography and LTA parameters varied; the strongest correlation was reported in the largest study and between ADP.%inhibition and ARADP.LTA |
| Cheng, D et al. (2020) [7] N = 110 |
Loading dose: aspirin 75 mg, ticagrelor 180 mg Maintenance dose: aspirin 75 mg, ticagrelor 90 mg TEG® and LTA assays were ordered simultaneously (no specific time given) |
TEG®5000 | ADP.%aggregation vs. ARADP.LTA: r = 0.5613, p < 0.01 ADP.MA vs. ARADP.LTA: r = 0.5567, p < 0.01 Net ADP.MA vs. ARADP.LTA: r = 0.5836, p < 0.01 |
AUCs (95% CI) for ROC curve analysis: * ADP.%aggregation (%) 0.8199 (0.734–0.886); cutoff = 64.6; sensitivity = 82.61; specificity = 80.46 ADP.MA (mm) 0.812 (0.726–0.880); cutoff = 45.6, sensitivity = 78.26; specificity = 81.61 Net ADP.MA (mm) 0.849 (0.768–0.910); cutoff = 26.3; sensitivity = 91.30; specificity = 73.56 |
- | ||
| Tang, N et al. (2015) [26] N = 178 |
Loading dose (prior to PCI)—therapy-naïve patients: 300 mg clopidogrel; patients previously on antiplatelet therapy: 75 mg clopidogrel Daily maintenance dose following surgery: 100 mg aspirin, 75 mg clopidogrel Blood samples collected 18–24 h post-PCI. |
TEG®5000 | - |
ADP.MA HTPR defined as >47 mm; positive predictive value = 31.6%, negative predictive value = 91.7% ADP.MPA HTPR defined as >46%; positive predictive value = 33.3%, negative predictive value 97.6% |
ADP.MA in patients with MACE vs. those without: 43.5 ± 20.6% vs. 33.0 ± 15.2, p = 0.021 ADP.MA > 47 mm independently predicted 6-month MACE (p = 0.013) |
MPA.MA in patients with MACE vs. those without: 52.9 ± 19.2% vs. 29.4 ± 18.7%, p = 0.002 MPA.MA > 46% independently predicted 6-month MACE (p = 0.001) |
|
| Li, G et al. (2017) [28] N = 425 |
DAPT: aspirin 100 mg/day, clopidogrel 75 mg/day Blood sample taken 3 days after treatment start |
TEG®5000 | ADP.%aggregation (11.8%) vs. ARADP.LTA (12.0%): r = 0.351, p = 0.01 | - | - | - | |
| Miao, L et al. (2017) [30] N = 177 |
Loading dose for therapy-naïve patients: 300 mg DAPT Daily maintenance dose: 100 mg aspirin, 75 mg clopidogrel Blood sample for TEG® and LTA assay taken one month after PCI |
TEG®5000 | Weak correlations between TEG and LTA | Detection rates of low DAPT response: LTA = 30.3%; thromobelastography = 45.5% |
- | - | |
* Using definition of HTPR as ARADP.LTA >46%; ADP: adenosine diphosphate; ARADP: ADP-induced aggregation rate; AUC: area under the curve; CI: confidence interval; DAPT: dual antiplatelet therapy; HTPR: high on-treatment platelet reactivity; LTA: light transmission aggregometry; MA: maximum amplitude; MPA.MA: ADP-induced maximum platelet aggregation; ROC: receiver operative characteristic. Tang XF 2015, Cheng D 2020 and Tang N 2015 were identified from PubMed, while Li 2017 and Miao 2017 were from the Chinese database.