VerifyNow® P2Y12 Test
“As the Guidelines recommend, it is very important to know which patients are at risk of bleeding. We use the VerifyNow P2Y12 Test as a key piece of data to help us decide when a patient can be taken to surgery. We have found by incorporating the test into our practice that we have been able to reduce the average pre-surgical patient length of stay by 3 days, resulting in significant cost savings. ”
Alex Zapolanski, M.D., Cardiac Surgery Director, The Valley Heart & Vascular Institute, New Jersey
Thienopyridines such as Plavix® (clopidogrel) and Effient® (prasugrel) block the P2Y12 ADP binding site on the platelet. The VerifyNow P2Y12 Test uses an ADP agonist to induce platelet activation and ascertain the level of platelet reactivity impaired by these medications. It also incorporates a second channel containing thrombin receptor agonists to approximate baseline reactivity so that there is no need to discontinue antiplatelet medication.
Studies show that up to one third of patients taking Plavix have low levels of platelet inhibition (reactivity)1,2 and do not receive the expected antiplatelet effect, which may increase the risk of ischemic events or unnecessarily delay patients from surgery. Additionally, coronary artery bypass graft (CABG) patients on antiplatelet medications have an increased risk of excessive perioperative bleeding. Clopidogrel (Plavix) is often discontinued for 5-7 days before surgery to reduce this bleeding risk.
Platelet Function Testing in the Guidelines
With the availability of newer antiplatelet agents (e.g. prasugrel), physicians are challenged to determine the right treatment strategies for individual patients while minimizing the risk of bleeding.
- The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) Task Force updated the 2011 ACCF/AHA Guidelines for the Management of Patients with UA/NSTEMI to incorporate a new recommendation under class IIb (B) that suggests that an approach of assessing platelet reactivity in combination with other procedural and patient characteristics may be considered to aid in patient management decisions.3
- The European Society of Cardiology (ESC) incorporated a new recommendation (IIb-B) to consider platelet function testing in its ACS guidelines, and also included a second recommendation that addressess modifying treatment strategies based on platelet reactivity measurements in selected cases (IIb-B).4
- The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists has also included a IIb(C) recommendation in the Blood Conservation Guidelines about point-of-care platelet reactivity testing for preoperative patient assessment, in order to reduce unnecessary delays prior to surgery.5
The VerifyNow P2Y12 Test allows clinicians to measure the actual level of platelet reactivity in patients who have taken P2Y12 inhibitors (e.g. Plavix and Effient) and who have discontinued them prior to surgery. By integrating this information with other clinical data, clinicians are able to make more informed decisions regarding a patient’s treatment and surgery schedule in their efforts to minimize bleeding risk and maximize patient safety.
INTENDED USE
The VerifyNow P2Y12 Test is a whole blood test used in the laboratory or point-of-care setting to measure the level of platelet P2Y12 receptor blockade.