ASA 500 mg

i.v.

Monitoring platelet function using the Multiplate® analyzer

> Status Quo in most clinics

Aspirin Clopidogrel

Abciximab

Tirofiban

Aspirin

Aspirin

Aspirin Clopidogrel

Clopidogrel

antiplatelet medications are given to a large number of patients

in most clinics no monitoring of antiplatelet therapy is performed Integrillin

Tirofiban

Clopidogrel

Aspirin

Aspirin

Integrillin

Abciximab

Aspirin

Clopidogrel

Clopidogrel

• simple

• whole-blood-based

• 1-3 different tests single channel

• high test price

cartridge-based

platelet function

tests

• complicated

• low standardisation

• used in research and reference labs

born aggregation

flow cytometry

Platelet Function

Analysis Market

• simple

• whole-blood-based

• 1-3 different tests single channel

• high test price

cartridge-based

platelet function

tests

• complicated

• low standardisation

• used in research and reference labs

born aggregation

flow cytometry

Platelet Function

Analysis Market

• easy-to-use

• multi-channel

• several tests available

• open system

Multiplate ®

firm adhesion and aggregation of platelets on the sensor surface enhances the electrical resistance between the 2 sensor wires

> principle of Multiplate® analysis

multiple platelet function analyzer

Compact (10“ x 15“ x 4“)

5 independent channels

Integrated computer

Windows XP based software

Automatic pipetting optionally available

> Multiplate® instrument

PTFE-coated stirrer

2 sensors with 2 electrodes each

plug portion

pipetting inlet

cup

> Multiplate® test cell

test 1+2

> Multiplate ® - Parameters

velocity

aggr

egat

ion

[AU

]

time [min]

aggregation

Area under the curve = AUC

0

20

40

60

80

100

120

140

160

0 1 2 3 4 5

test 1 test 2

6

:

TRAP

platelet activation

GpIIb /IIIa receptor

exposure

degranulation

ADP

Arachidonic Acid

Collagen

ArA1

COX

TXA2

TXA2

COLtest

ASPItest

TRAPtest

ADPtestADPtest

PGE1 ADPtest HS (ADP + PGE1)

activation

inhibition

GpIIb/IIIa antagonists:

Reopro ® (abciximab)Aggrastat ® (Tirofiban)Integrillin ® (Eptifibatid)

Aspirin ®NSAR

Clopidogrel PrasugrelCangrelor

1 release of arachidonic acid

> Multiplate® test procedures

>ADPtest HS: ADP + Prostaglandin E1

Activation Receptor exposure

ADP

PGE1

Ca2+

+-Clopidogrel

Binding of ADP to the P2Y12 receptor lowers cAMP and enhances release of Ca2+ from intracellular stores (+). Plavix interferes with this interaction. PGE1 binds to the platelet and raises cAMP which reduces Ca2+ mobilisation (-).

Ca2+

Ca2+ Ca2+

Ca2+

Ca2+ Ca2+

Ca2+

Ca2+

cAMP

cAMP