Platelet Function Analyzers

[kholshoe]

Looking for feedback on the various platelet function analyzers!  We are not currently performing this type of testing, but there seems to be an increased interest from our physicians.

 

We are in the process of comparing the PFA-100, Chronologs, and Accumetric's VerifyNow.  We are just in the beginning stages of looking into this. 

 

Is anyone out there using any of these analyzers?  I'd like to hear some thoughts...

[tbostock]

We were also looking at platelet function analyzers but were looking at Rotem and TEG; we felt them to give more of a complete picture of coagulopathy in the patient.

But, alas, for now, no money in the budget.

We would love it if you post your experiences/opinions of each after you evaluate them.

[SMILLER]

I understand that the problem with thromboelastigram-type device like TEG are that they are tedious to set up, run and interpret.  I would appreciate any info on how the TEG or Rotem is currently being used.  Here, our trauma/OR people would like to see them being used, but so far we have held off.

 

As far as plartelet function analyzers, after we dropped bleeding times a few years ago we started using the PFA-100.  It is OK for a general screen and for detecting an aspirin effect.  Later we added the Verify Now -- mostly for P2Y12 antagonist detection (like Plavix) -- it also is used to test for aspirin.  Both of these analyzers are easy to use.  They are essentially POC devices.

 

We have not dropped using the PFA becuase it is still useful as a general screen.  Both analyzers can be affected by low platelet counts.  The PFA is also affected by low hematocrits.

 

Scott

[kholshoe]

Well there's more to the story really. LOL. Our OR team really wants the TEG, but they kinda want lab to be responsible for it. We also feel the interpretation is complex. The perfusionists, anesthesiologists, and surgeons could use it in the OR themselves - but that is a less attractive option to them as it means they will likely be called in to operate it.

Scott - does the PFA 100 only screen for aspirin effect and the VerifyNow screen for additional therapies?

[kholshoe]

Well there's more to the story really. LOL. Our OR team really wants the TEG, but they kinda want lab to be responsible for it. We also feel the interpretation is complex. The perfusionists, anesthesiologists, and surgeons could use it in the OR themselves - but that is a less attractive option to them as it means they will likely be called in to operate it.

Scott - does the PFA 100 only screen for aspirin effect and the VerifyNow screen for additional therapies?

[SMILLER]

Scott - does the PFA 100 only screen for aspirin effect and the VerifyNow screen for additional therapies?

 

The PFA has two cartridges.  The first has EPI in it - it is for a general screen.  If its normal the platelets are working normally.  If the EPI is abnormal, you run a cart with ADP.  If the effect is due to aspirin, this will be normal.  Otherwise, if both results are elevated, it is probably due to something else.  As far as I know, the people at Dade have not figured out how to use the PFA to reliabley detect other stuff, like Plavix.

 

The Verify Now has specific carts for Plavix-like (P2Y12) inhibitors, aspirin, and the IIb/IIIa inhibitors.

 

I would suggest you ask your people pushing for you running a TEG for them to ask for a reference.  Do they know of another hospital that uses the TEG like they want to?  I am not sure there are alot of them.

 

Scott

[tbostock]

When I spoke to the TEG rep, he stated that in the hospitals that he knows that have it, the OR wanted it. It started out being located there, until QC was not done, etc. Then it was re-located to the Lab. So the OR collects the sample and sends it immediately to the Lab where it is performed and interpreted.

[kholshoe]

Scott,

 

Thanks for the information!  Our OR team has actually already listed several references for us - most of which are out-of-state (somewhere they've worked previously).  I believe there was one subsidiary of ours that is using it currently, and it is located in the OR.  From what I've reviewed, it looks like it would be a time-intensive procedure to run.  Also looks like there is alot of interpretation involved with the results.  One rep suggested only having a few people learn how to use the TEG.  I don't know about you guys, but we are so scantily staffed - we can't take on yet another analyzer that only a few people know how to use (causes all sorts of scheduling problems).  We already have this problem with other instruments...