Methods for the Measurement of Platelet Function

Alan D. Michelson, MD
This article discusses the advantages and disadvantages of methods for the measure-
ment of platelet function. The focus is on tests that can be used to monitor antiplatelet
activity in the setting of cardiovascular disease and potentially predict thrombosis
and bleeding. The tests described are platelet aggregometry; impedance aggregom-
etry; VerifyNow (Accumetrics, San Diego, CA); Plateletworks (Helena Laboratories,
Beaumont, TX); platelet surface P-selectin, platelet surfaceactivated glycoprotein
IIb/IIIa, and leukocyteplatelet aggregates; TEG Platelet Mapping system (Haemo-
scope, Niles, IL); Impact cone and plate(let) analyzer (DiaMed, Cressier, Switzerland);
Platelet Function Analyzer-100 (Siemens Healthcare Diagnostics, Inc., Deerfield, IL);
phosphorylation of vasodilator-stimulated phosphoprotein; serum thromboxane B2; and
urinary 11-dehydro thromboxane B2. Some of the factors that differentiate these tests are
sample volume requirements, the use of whole blood, the presence of shear, point-of-care
status, need for a technician, and expense. 2009 Published by Elsevier Inc. (Am J
Cardiol 2009;103[suppl]:20A26A)

Platelets circulate in a resting discoid form (Figure 1, lower
left).1 Platelet activation results in the formation of filopodia
and lamellipodia (Figure 1, lower middle), and then platelet
aggregation (Figure 1, upper right). The goal of antiplatelet
drug therapy is to prevent or reverse this process.
The mechanisms of action of antiplatelet drugs are well
known. Aspirin irreversibly acetylates serine 529 of cyclo-
oxygenase1 (COX-1), resulting in inhibition of the generation of
thromboxane A2 from platelets.2 However, aspirin may have
other mechanisms of action, such as via acetylation of fibrin-
ogen, von Willebrand factor, and other molecules.3 Thieno-
pyridines (including ticlopidine and clopidogrel) irreversibly
inhibit platelet P2Y12 adenosine diphosphate (ADP) recep-
tors,4 and glycoprotein (GP) IIb/IIIa antagonists (including
abciximab, eptifibatide and tirofiban) inhibit the final common
pathway of platelet-to-platelet aggregation.5
Tests of platelet function attempt to measure the point in the
activation process reached by the platelets of an individual
patient. Possible reasons for measuring platelet function in
patients include screening, diagnosis, monitoring antiplatelet
therapy, monitoring prohemostatic therapy, predicting throm-
bosis, predicting bleeding, and assessing stored platelets.6
This article discusses methods for the measurement of
platelet function and describes their advantages and disad-
vantages. The discussion focuses on platelet function tests
that can be used in the setting of cardiovascular diseases to
monitor antiplatelet therapy and potentially predict throm-
Center for Platelet Function Studies, University of Massachusetts Med-
ical School, Worcester, Massachusetts, USA.
Statement of author disclosure: Please see the Author Disclosures
section at the end of this article.
Address for reprints: Alan D. Michelson, MD, Center for Platelet
Function Studies, University of Massachusetts Medical School, 55 Lake
Avenue North, Worcester, Massachusetts 01655.
E-mail address: michelsa@ummhc.org.
bosis and bleeding. Methods for the measurement of platelet
function in patients are summarized in Table 1.7
Specific Platelet Function Assays
Platelet aggregometry: Turbidimetric platelet aggre-
gometry in platelet-rich plasma was originally described
by Gustav Born8 and John OBrien.9 The end point of this
assay is the change in light transmission as a result of
integrin IIb3 (GP IIb/IIIa) dependent platelet-to-platelet
aggregation in response to an agonist.10 The main advan-
tage of platelet aggregometry is that it is the historical
gold standard, although Born and OBrien designed the
test as a measure of defective platelet function, not as a
predictor of thrombosis. The disadvantages of platelet
aggregometry are that platelet-rich plasma needs to be
prepared, the test is time consuming, and a high sample
volume is required.
Impedance aggregometry: Platelet aggregation can be
measured in anticoagulated whole blood by the use of im-
pedance rather than turbidimetry.6,10 Impedance is the same
method that is used in a Coulter counter. Although imped-
ance aggregometry and turbidimetric aggregometry are con-
ceptually measuring the same thingintegrin IIb3 (GP
IIb/IIIa) dependent platelet-to-platelet aggregationthe
size of the platelet aggregates measured by impedance ag-
gregometry is smaller than that of the platelet aggregates
measured by turbidimetric aggregometry. The major advan-
tage of impedance aggregometry is that it is more physio-
logic, in that it is a whole blood assay that does not require
the separation of platelet-rich plasma. However, impedance
aggregometry still requires a fairly high sample volume, and
the assay is still time consuming and expensive because a
technician needs to monitor the agonist-induced aggregation
over a number of minutes.

0002-9149/09/$ see front matter 2009 Published by Elsevier Inc. www.AJConline.org

doi:10.1016/j.amjcard.2008.11.019
 Michelson/Methods for the Measurement of Platelet Function 21A

Figure 1. Platelet shape change and aggregation. Scanning electron micrograph of resting (lower left), partially activated (lower middle), and fully activated
platelets (upper right), showing the accompanying shape changes, formation of filopodia and lamellipodia, and platelet aggregation. (Image provided courtesy
of John W. Weisel, Chandrasekaran Nagaswami, and Rustem I. Litvinov, Department of Cell and Developmental Biology, University of Pennsylvania School
of Medicine, Philadelphia, Pennsylvania.) (Reprinted with permission from Elsevier/Academic Press.)1

VerifyNow: VerifyNow (Accumetrics, San Diego, CA),
formerly known as the Ultegra rapid platelet function ana-
lyzer, is a point-of-care device that, as with turbidimetric
aggregation and impedance aggregation, is based on inte-
grin IIb3 (GP IIb/IIIa) dependent platelet aggregation.11
However, platelet aggregation is augmented by the presence
of fibrinogen-coated beads (Figure 2).11 Dissimilar to turbi-
dimetric aggregation, but similar to impedance aggregation,
the VerifyNow assay is performed in anticoagulated whole
blood. Other advantages of the VerifyNow assay are that it is
simple and rapidly performed and requires only a small sample
volume. Furthermore, it is a true point-of-care device in that no
pipetting is required. Although the VerifyNow assay has a
limited hematocrit and platelet count range, this applies to
many tests of platelet function.
Plateletworks: Plateletworks (Helena Laboratories,
Beaumont, TX) is another device that is based on integrin
IIb3 (GP IIb/IIIa) dependent platelet aggregation.6 It is a
conceptually simple method in which the platelet count is
compared in samples with and without agonists. Minimal
sample preparation is required, and it is a whole blood
assay. The main disadvantage of Plateletworks is that it is
not well studied.
Platelet surface P-selectin, platelet surfaceactivated
GP IIb/IIIa, and leukocyte-platelet aggregates: Platelet
surface P-selectin, activated integrin IIb3 (GP IIb/IIIa),
and leukocyteplatelet aggregates can be measured by flow
cytometry.12 Integrin IIb3 is normally present on the
platelet surface, but it is in a resting conformation. With
platelet activation, the conformation of the integrin IIb3
changes, and a specific monoclonal antibody, PAC-1, only
binds to integrin IIb3 when it is in this activated confor-
mation.13 Thus, a PAC-1negative platelet is a resting plate-
let, and a PAC-1positive platelet is an activated platelet.
When platelets are activated, they degranulate, and P-selec-
tinwhich is normally present on the -granule membrane,
not the platelet plasma membrane becomes exteriorized on
the platelet surface.14 Thus, a P-selectinnegative platelet is a
resting platelet, and a P-selectinpositive platelet is an acti-
vated platelet. In addition, P-selectinpositive platelets very
rapidly bind to leukocytes via their constitutively expressed
counter receptor, P-selectin GP ligand 1.14,15 Therefore, cir-
culating leukocyteplatelet aggregates (especially mono-
cyteplatelet aggregates) are a more sensitive marker of in
vivo platelet activation than are circulating P-selectinpos-
itive platelets.15
The advantages of the flow cytometric measurement of
platelet function by platelet surface P-selectin, activated inte-
grin IIb3, and/or leukocyteplatelet aggregates are that
these assays require a very low sample volume, and they are
whole blood assays. Furthermore, these assays have been stan-
dardized such that fixed samples can be mailed to a core
laboratory; this is particularly useful in multicenter clinical
trials.16 The disadvantages of these assays are that sample
preparation is required, and they require an expensive machine
(a flow cytometer) and an experienced technician. These as-
says are therefore currently mainly research tools.
22A The American Journal of Cardiology (www.AJConline.org) Vol 103 (3A) February 2, 2009

Table 1
Methods for the measurement of platelet function in patients
Test Basis Advantages Disadvantages

Turbidimetric aggregometry
Impedance aggregometry
VerifyNow*
Plateletworks
Platelet surface P-selectin,
platelet surface-activated GP
IIb/IIIa, leukocyte-platelet
aggregates
TEG Platelet Mapping system
Impact cone and plate(let)
analyzer
PFA-100
VASP
Serum thromboxane B2
Urinary 11-dehydro
thromboxane B2 creatinine
ratio
Platelet aggregation Historical gold standard High sample volume
Sample preparation
Time consuming
Platelet aggregation Whole blood assay High sample volume
Sample preparation
Time consuming
Platelet aggregation Simple, rapid Limited hematocrit and
Point-of-care (no pipetting required) platelet count range
Low sample volume
Whole blood assay
Platelet aggregation Minimal sample prep Not well studied
Whole blood assay
Activation-dependent changes in Low sample volume Sample preparation
platelet surface Whole blood assays Requires a flow cytometer and
Fixed samples can be mailed to a core experienced technician
laboratory
Platelet contribution to clot strength Whole blood assay Limited studies
Clot information Requires pipetting
Shear-induced platelet adhesion Simple, rapid Requires pipetting
Point of care Instrument not widely used
Low sample volume
No sample prep
Whole blood assay
Shear
In vitro cessation of high shear Simple, rapid Dependent on von Willebrand
blood flow by platelet plug Point-of-care factor and hematocrit
Low sample volume Requires pipetting
No sample prep Does not correlate well with
Whole blood assay clopidogrel therapy
Shear
Activation-dependent signaling Dependent on clopidogrel target, Sample preparation
P2Y12 Requires a flow cytometer and
Low sample volume experienced technician
Whole blood assay
Blood samples can be mailed at room
temperature to a core laboratory
Activation-dependent release from Directly dependent on aspirins target, Indirect measure
platelets COX-1 Not platelet specific
Stable urinary metabolite of Directly dependent on aspirins target, Indirect measure
thromboxane B2 COX-1 Not platelet specific

COX-1 cyclooxygenase-1; GP glycoprotein; PFA platelet function analyzer; TEG thromboelastography; VASP vasodilator-stimulated
phosphoprotein.
* VerifyNow (Accumetrics, San Diego, CA).

Plateletworks (Helena Laboratories, Beaumont, TX).

TEG Platelet Mapping system (Haemoscope, Niles, IL).

Impact cone and plate(let) analyzer (DiaMed, Cressier, Switzerland).

Platelet Function Analyzer-100 (Siemens Healthcare Diagnostics, Inc., Deerfield, IL).
Modified with permission from Circulation.7

TEG Platelet Mapping system: Although thromboelas-
tography (TEG) was invented 50 years ago, it has recently
been updated to a more platelet-specific test in the form of
the TEG Platelet Mapping system (Haemoscope, Niles,
IL).6 The particular advantage of the TEG Platelet Mapping
system is that, in addition to measuring platelet function, it
specifically measures the platelet contribution to clot
strength. Although platelet function and coagulation are
often considered separately, they are, of course, completely
interrelated processes.17 Therefore, it may be advantageous
to measure the 2 processes in the 1 assay.18 An additional
advantage of the TEG Platelet Mapping system is that it is
a whole blood assay. Its disadvantages are that it is not a
true point-of-care instrument in that it requires pipetting,
and there are a limited number of published studies involv-
ing this assay.18
Impact cone and plate(let) analyzer: The Impact cone
and plate(let) analyzer (DiaMed, Cressier, Switzerland) was
originally developed in Israel by David Varon and Naphtali
 Michelson/Methods for the Measurement of Platelet Function 23A

Figure 2. Determination of platelet function with the VerifyNow system (Accumetrics, San Diego, CA). The mixing chamber contains a platelet agonist
(thrombin receptoractivating peptide (TRAP) [iso-TRAP], arachidonic acid, or adenosine diphosphate [ADP]) and fibrinogen-coated beads. After antico-
agulated whole blood is added to the mixing chamber, the platelets become activated. The activated glycoprotein (GP) IIb/IIIa receptors on the platelets bind
via the fibrinogen on the beads and cause agglutination of the platelets and the beads. Light transmittance through the chamber is measured and increases
as the agglutinated platelets and beads fall out of solution. Direct pharmacologic blockade of GP IIb/IIIa receptors with a GP IIb/IIIa antagonist or the
prevention of their expression by the inhibition of arachidonic acidinduced or ADP-induced platelet activation diminishes agglutination in proportion to the
degree of platelet inhibition achieved. (Reprinted with permission from Elsevier/Academic Press.11)

Savion. The end point of this assay is shear-induced platelet
adhesion. This is potentially quite advantageous because
shear is very important for platelet function,19 particularly in
the setting of coronary artery disease (CAD).20 Although
turbidimetric aggregometry and impedance aggregometry
are performed in stirred samples, the shear rate in these
assays is an order of magnitude below the shear rate that is
relevant to CAD. The research version of the Impact ana-
lyzer has an adjustable shear rate, and, in the clinical ver-
sion, the shear rate is directly relevant to that in CAD.21
Additional advantages of the Impact are simplicity, rapid
readout, low sample volume, no sample preparation, and the
fact that it is a whole blood assay. The disadvantages of the
Impact are that it is not a true point-of-care instrument
because it requires pipetting. Additionally, although there
are a number of published studies describing this assay,21
the instrument is not widely used.
Platelet Function Analyzer-100: The Platelet Function
Analyzer100 (PFA-100; Siemens Healthcare Diagnostics,
Inc., Deerfield, IL) also has the advantage of including a
physiologically relevant shear rate.22 This device has been
referred to as an in vitro bleeding time (not an ideal term),
but the concept is that of an in vitro method for looking at
cessation of blood flow in a high-shear environment, as
determined by the closure time of an aperture by the for-
mation of a platelet plug. In addition to shear, the advan-
tages of the PFA-100 are its simplicity, rapid readout, low
sample volume, no requirement for sample preparation, and
the fact that it is a whole blood assay. The disadvantages of
the PFA-100 are that the closure time is very dependent on von
Willebrand factor levels and hematocrit. Although initial pipetting
of the blood sample is necessary, the sample is simply inserted
into a cassette, a button is pressed, and a rapid readout is obtained.
The PFA-100 has 2 available cartridges: a collagen epineph-
rine cartridge and a collagenADP cartridge. The PFA-100
has been widely used to study aspirin response.6,23 Surpris-
ingly, the PFA-100, even with the collagenADP cartridge,
is not sensitive to clopidogrel therapy.
Phosphorylation of vasodilator-stimulated phospho-
protein: Phosphorylation of vasodilator-stimulated phos-
phoprotein (VASP) for the measurement of P2Y12 antago-
nism is available commercially as a flow cytometry kit
(BioCytex, Marseilles, France).12 Prostaglandin E1 binds to
its inositol phosphate receptor on the platelet surface and
signals through a G stimulatory protein and adenylyl cy-
clase to convert adenosine triphosphate to cyclic adenosine
monophosphate and then, through protein kinase A, to con-
vert VASP to phosphorylated VASP (VASP-P) (Figure 3).24
ADP binds to its P2Y12 receptor on the platelet surface and
signals through a G inhibitory protein to inhibit prostaglan-
din E1induced signaling through adenylyl cyclase. P2Y12
antagonists (for example, the active metabolite of clopi-
dogrel) inhibit this ADP-induced effect. Therefore, in the
presence of both prostaglandin E1 and ADP, VASP-P is
directly proportional to the degree of P2Y12 antagonism
(Figure 3). VASP-P is measured by whole blood flow cy-
tometry, using permeabilization and a monoclonal antibody
specific for the phosphorylated form of VASP.
24A The American Journal of Cardiology (www.AJConline.org) Vol 103 (3A) February 2, 2009
Figure 3. Vasodilator-stimulated phosphoprotein (VASP) assay for the
measurement of P2Y12 antagonism. AC adenylyl cyclase; ADP
adenosine diphosphate; ATP adenosine triphosphate; cAMP cyclic
adenosine monophosphate; PGE1 prostaglandin E1; PKA protein
kinase A; VASP-P phosphorylated vasodilator-stimulated phosphopro-
tein. (Adapted with permission from Elsevier/Academic Press.24)
The advantages of the VASP assay are that it is depen-
dent on the target of clopidogrel (P2Y12), and it involves
low sample volume and whole blood assays. In addition,
quite remarkably, citrated blood samples can be mailed at
room temperature to a core laboratory; this is particularly
useful in multicenter clinical trials.16 The disadvantages of
the VASP assay are sample preparation and the requirement
for a flow cytometer and an experienced technician.
Serum thromboxane B2: Thromboxane A2 is released
from platelets in an activation-dependent manner, after
which it is rapidly converted to its stable metabolite, throm-
boxane B2.25 The advantage of measuring serum thrombox-
ane B2 is that it is directly dependent on aspirins target,
COX-1. The disadvantages of measuring serum thrombox-
ane B2 are that it is an indirect measure in the sense that
platelets are not directly assayed, and it may not be entirely
platelet specific.26
Urinary 11-dehydro thromboxane B2: Urinary 11-de-
hydro thromboxane B2 is a stable urinary metabolite of
thromboxane A2.25 The advantage of measuring urinary
11-dehydro thromboxane B2 is that it is directly dependent
on aspirins target, COX-1. The disadvantages of measuring
urinary 11-dehydro thromboxane B2 are that it is an indirect
measure in the sense that platelets are not directly assayed,
Table 2
Platelet function tests for monitoring aspirin
Thromboxane as the end point
Serum thromboxane B2
Urinary 11-dehydro thromboxane B2
Arachidonic acid as the stimulus
Platelet aggregometry (turbidimetric)
Platelet aggregometry (impedance)
VerifyNow* aspirin assay
Plateletworks
Platelet surface-activated glycoprotein IIb/IIIa, platelet surface
P-selectin, leukocyte-platelet aggregates (flow cytometry)
TEG Platelet Mapping system
Impact cone and plate(let) analyzer
Other
Platelet Function Analyzer100
* VerifyNow (Accumetrics, San Diego, CA).
Plateletworks (Helena Laboratories, Beaumont, TX).
TEG Platelet Mapping system (Haemoscope, Niles, IL).
Impact cone and plate(let) analyzer (DiaMed, Cressier, Switzerland).
Platelet Function Analyzer-100 (Siemens Healthcare Diagnostics, Inc.,
Deerfield, IL).
Adapted with permission from Eur Heart J.28
and it may not be entirely platelet specific.26 The potential
effects of renal function are obviated by measuring the ratio
of urinary 11-dehydro thromboxane B2 to creatinine.27
Approach to Monitoring Antiplatelet Therapy
Platelet function tests for monitoring aspirin: Consid-
ering this cornucopia of available platelet function tests,
how should the effects of aspirin be monitored? There are 3
categories of available tests (Table 2).28
First, thromboxane could be used as the end point, with
an assay of either serum thromboxane B2 or urinary 11-
dehydro thromboxane B2. The advantage of this approach is
that aspirin specifically inhibits platelet COX-1 and, there-
fore, thromboxane generation. A possible disadvantage is
that nearly all patients who are compliant with taking aspi-
rin are inhibited as judged by serum thromboxane B2 or
urinary 11-dehydro thromboxane B2 assays but not neces-
sarily as judged by other assays.3,29
Second, arachidonic acid can be used as the stimulus.
The advantage of this approach is that arachidonic acid
results in specific signaling through COX-1, the point of
inhibition by aspirin. Again, the assumption is that all of the
effects of aspirin result from its inhibition of COX-1, which
might not be entirely true.3,29 With arachidonic acid as the
stimulus, one of a number of end points could be chosen,
including turbidimetric platelet aggregometry, impedance
platelet aggregometry, the VerifyNow aspirin assay,
Plateletworks, platelet surfaceactivated GP IIb/IIIa, plate-
let surface P-selectin, leukocyteplatelet aggregates, the
TEG Platelet Mapping system, and the Impact cone and
plate(let) analyzer. However, older studies of the Veri-
fyNow (Ultegra rapid platelet function analyzer), including
the widely quoted study by Chen et al,30 used propyl gallate,
not arachidonic acid, as the stimulus.
 Michelson/Methods for the Measurement of Platelet Function
Table 3
Platelet function tests for monitoring clopidogrel
P2Y12-specific tests
VASP phosphorylation (flow cytometry)
ADP-stimulated tests
Platelet aggregometry (turbidimetric)
Platelet aggregometry (impedance)
VerifyNow* P2Y12 assay
Plateletworks
Platelet surfaceactivated GP IIb/IIIa, platelet surface P-selectin,
leukocyte-platelet aggregates (flow cytometry)
TEG Platelet Mapping system
Impact cone and plate(let) analyzer
ADP adenosine diphosphate; GP glycoprotein; TEG throm-
boelastography; VASP vasodilator-stimulated phosphoprotein.
* VerifyNow (Accumetrics, San Diego, CA).
Plateletworks (Helena Laboratories, Beaumont, TX).
TEG Platelet Mapping system (Haemoscope, Niles, IL).
Impact cone and plate(let) analyzer (DiaMed, Cressier, Switzerland).
Adapted with permission from Eur Heart J.28
Table 4
Platelet function tests for monitoring glycoprotein (GP) IIb/IIIa
antagonists
Platelet aggregation
Platelet aggregometry (turbidimetric)
Platelet aggregometry (impedance)
VerifyNow* TRAP assay
Plateletworks
Activation-dependent conformational change in GP IIb/IIIa by flow
cytometry
Platelet surfaceactivated GP IIb/IIIa (PAC-1)
Ligand-induced binding site
TRAP thrombin receptor-activating peptide.
* VerifyNow (Accumetrics, San Diego, CA).
Plateletworks (Helena Laboratories, Beaumont, TX).
Third, the PFA-100 has been widely used to study the
response of platelets to aspirin.31 Unlike the first 2 catego-
ries in Table 2, the PFA-100 is not COX-1 specific. Is that
a disadvantage or could it be an advantage if aspirin also has
nonCOX-1mediated inhibitory effects3,29 on platelets?
Platelet function tests for monitoring clopidogrel:
How should the effects of clopidogrel be monitored? There
are 2 categories of available tests (Table 3).28 First, only the
VASP phosphorylation assay is specific with regard to sig-
naling through P2Y12 and therefore to the platelet inhibitory
effects of clopidogrel (Figure 3). Second, ADP can be used
as the stimulus. The alternative approach is to add ADP and
look at one of a number of end points. However, it is
important to consider that ADP binds to its platelet surface
P2Y1 receptor as well as to its platelet surface P2Y12 re-
ceptor24 and that the active metabolite of clopidogrel only
inhibits at P2Y12, not P2Y1.4 Therefore, the effects of ADP
on platelet function reflect not only the inhibitory effects of
clopidogrel on P2Y12 but also the unblocked effect of ADP-
induced signaling through P2Y1. With ADP as the stimulus,
one of a number of end points could be chosen, including
25A
turbidimetric platelet aggregometry, impedance platelet ag-
gregometry, the VerifyNow P2Y12 assay, Plateletworks,
platelet surfaceactivated GP IIb/IIIa, platelet surface P-
selectin, leukocyteplatelet aggregates, the TEG Platelet
Mapping system, and the Impact cone and plate(let)
analyzer.
Platelet function tests for monitoring GP IIb/IIIa
antagonists: GP IIb/IIIa antagonists can be monitored by 2
categories of tests (Table 4). First, because GP IIb/IIIa antag-
onists block the final common pathway of platelet aggrega-
tion,5 inhibition of platelet aggregation can be assessed by one
of a number of end points: turbidimetric platelet aggregometry,
impedance aggregometry, VerifyNow thrombin receptoracti-
vating peptide assay, or Plateletworks. Second, because plate-
let aggregation cannot occur without a conformational change
in integrin IIb3 (GP IIb/IIIa), flow cytometry can be used to
measure a conformational change in platelet surfaceactivated
GP IIb/IIIa reported by monoclonal antibody PAC-112,13 or a
ligand-induced binding site.32,33
Point-of-Care Assays
Point-of-care assays (also referred to as point-of-service
assays) have potentially great advantages. For example,
they help with immediate decision making about the type
and dose of antiplatelet therapy in the interventional cardi-
ology suite. A rigorous definition of a point-of-care assay is
an assay that meets all of the following criteria: use at or
near the patient bedside; easy to use, requiring no special
skills; no sample processing; no pipetting; rapid readout.
The only currently available device that fits these criteria is
VerifyNow.11 However, 2 other devices are in develop-
ment: T-Guide (ThromboVision, Houston, TX), based on
agonist-induced laser light scattering; and PRT (PlaCor,
Plymouth, MN), based on a finger stick capillary blood
sample with no exogenously added agonist.
Conclusion
A wide variety of tests are available for the measurement of
platelet function, and each has its advantages and disadvan-
tages. The most specific tests for the effect of aspirin are
directly dependent on COX-1 (ie, the measurement of
thromboxane or the use of arachidonic acid as a stimulus).
However, it remains unclear whether the measurement of
the potential nonCOX-1 effects of aspirin may also be
important to measure. The most specific test for the effect of
clopidogrel is the VASP phosphorylation assay. Point-of-
care assays for the measurement of the effects of aspirin and
clopidogrel (eg, VerifyNow Aspirin Assay and VerifyNow
P2Y12 Assay) have great practical advantages in the clinical
setting.
26A The American Journal of Cardiology (www.AJConline.org) Vol 103 (3A) February 2, 2009
Author Disclosure
The author who contributed to this article has disclosed the
following industry relationships.
Alan D. Michelson, MD, has served as a consultant to
Eli Lilly and Company/Daiichi Sankyo, Inc; has received
honoraria from sanofi-aventis/Bristol-Myers Squibb Com-
pany; and has received research grants from Accumetrics,
Inc, Arena Pharmaceuticals, Inc, Dade Behring Inc, Eli
Lilly and Company/Daiichi Sankyo, Inc, GL Synthesis, Inc,
McNeil Consumer Healthcare, and sanofi-aventis/Bristol-
Myers Squibb Company.
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