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


This case illustrates the challenges encountered by the Blood Bank and Coagulation Laboratory when a patient receiving clopidogrel or a related agent requires urgent surgical intervention. In the patient described above, the VerifyNow result increased from 137 to 190 PRUs after apheresis platelets were transfused. The second result suggests a persistent clopidogrel effect (<208 PRUs); however, it is unknown whether this value translates into a need for additional platelets. While some clinical guidelines recommend the use of platelet function tests to guide reversal of ADP inhibitors, current commercial assays were not designed for this purpose, nor have there been controlled clinical trials to determine their effectiveness in this setting. In addition, results may be method dependent. Laboratorians should discuss these limitations with the relevant clinical services.