Ann Lab Med 2019; 39(1): 23-30  https://doi.org/10.3343/alm.2019.39.1.23
Effectiveness of Platelet Function Analyzer-100 for Laboratory Detection of Anti-Platelet Drug-Induced Platelet Dysfunction
Oh Joo Kweon, M.D.1,2, Yong Kwan Lim, M.D.2, Bohyun Kim, M.D., Ph.D.3, Mi-Kyung Lee, M.D., Ph.D.2, and Hye Ryoun Kim, M.D., Ph.D.2
1Department of Laboratory Medicine, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Korea; 2Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea; 3Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
Corresponding author: Hye Ryoun Kim, M.D.
https://orcid.org/0000-0002-9229-9665
Department of Laboratory Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea
Tel: +82-2-6299-2718
Fax: +82-2-6298-8630
E-mail: hyekim@cau.ac.kr
Received: November 28, 2017; Revised: May 24, 2018; Accepted: August 16, 2018; Published online: January 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: High on-treatment platelet reactivity (HTPR) is the phenomenon wherein patients exhibit normal platelet activity in laboratory testing despite adequate adherence to anti-platelet treatment. We investigated the detection rates of Platelet Function Analyzer (PFA)-100 (Dade Behring AG, Düdingen, Switzerland) for drug-induced platelet dysfunction and analyzed potential contributors to HTPR with practical PFA-100 data over six years.
Methods: We used data from 6,957 patients who underwent PFA-100 testing after receiving aspirin, clopidogrel, or non-steroidal anti-inflammatory drugs (NSAIDs). Of these, 6,163 patients were tested with only the collagen/epinephrine cartridge (Col/EPI) of PFA-100; 794 were tested with both Col/EPI and the collagen/ADP cartridge (Col/ADP). We calculated PFA-100 closure time (CT) for each drug and compared the clinical and laboratory characteristics of the patients with prolonged CTs and normal CTs (i.e., HTPR).
Results: In Col/EPI, 73.2% (365/499), 72.6% (390/537), and 55.3% (3,442/6,228) patients showed prolonged CTs for aspirin, clopidogrel, and NSAIDs, respectively. In Col/ADP, prolonged CTs were observed in 37.4% (34/91), 43.2% (35/81), and 29.6% (200/676) of patients receiving aspirin, clopidogrel, and NSAIDs, respectively. Of the patients tested with both cartridges, 88.9% (48/54), 95.3% (41/43), and 89.0% (577/648) of the patients receiving aspirin, clopidogrel, and NSAIDs had prolonged CTs, and 10.0% (79/794) showed normal CTs regardless of drugs. For clopidogrel users (both cartridges), there were more patients with malignancies in the normal CT than prolonged CT group.
Conclusions: PFA-100 is not sufficiently effective for laboratory screening of drug-induced platelet dysfunction. Malignancy may contribute to clopidogrel-related HTPR in PFA-100.
Keywords: Platelet Function Analyzer-100, Aspirin, Clopidogrel, Non-steroidal anti-inflammatory drugs, High on-treatment platelet reactivity

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