Laboratory Monitoring of Platelet P2Y12 Receptor Inhibitors and Reversal of Antiplatelet Agents

An ACLPS Critical Review

Lisa Senzel, MD, PhD; Tahmeena Ahmed, MBBS; Eric D. Spitzer, MD, PhD


Am J Clin Pathol. 2019;152(1):1-6. 

In This Article

Case Presentation

A 48-year-old man presents with a middle cerebral artery hemorrhagic infarct with intracerebral hemorrhage (ICH). He takes clopidogrel for carotid disease and had a cardiac transplant following viral cardiomyopathy at age 30 years. Neurosurgeons plan to evacuate the ICH following correction of the platelet response. The VerifyNow P2Y12 Response Assay (Accriva Diagnostics) result is 137 P2Y12 reaction units (PRUs), indicating a clopidogrel effect. After platelets are transfused, the neurosurgery service orders a repeat VerifyNow test that produces a result of 190 PRUs, indicating a persistent clopidogrel effect. Additional platelet units are ordered. Does the second VerifyNow result indicate that additional platelets are needed? Will additional platelet transfusion correct the platelet response result?