Monitoring platelet function using the Multiplate® analyzer ASA 500 mg i.v.

antiplatelet medications are given to a large number of patients > Status Quo in most clinics Tirofiban Clopidogrel Aspirin Clopidogrel Clopidogrel Clopidogrel Aspirin Aspirin Clopidogrel Aspirin antiplatelet medications are given to a large number of patients in most clinics no monitoring of antiplatelet therapy is performed Aspirin Integrillin Aspirin Abciximab Clopidogrel Abciximab Aspirin Tirofiban Integrillin

Platelet Function Analysis Market simple whole-blood-based 1-3 different tests single channel high test price complicated low standardisation used in research and reference labs cartridge-based platelet function tests born aggregation flow cytometry

Platelet Function Analysis Market Multiplate ® simple whole-blood-based 1-3 different tests single channel high test price complicated low standardisation used in research and reference labs Multiplate ® easy-to-use multi-channel several tests available open system cartridge-based platelet function tests born aggregation flow cytometry

> principle of Multiplate® analysis firm adhesion and aggregation of platelets on the sensor surface enhances the electrical resistance between the 2 sensor wires

> Multiplate® instrument multiple platelet function analyzer Compact (10“ x 15“ x 4“) 5 independent channels Integrated computer Windows XP based software Automatic pipetting optionally available

2 sensors with 2 electrodes each > Multiplate® test cell 2 sensors with 2 electrodes each pipetting inlet cup plug portion PTFE-coated stirrer

> Multiplate ® - Parameters velocity aggregation [AU] time [min] aggregation Area under the curve = AUC 20 40 60 80 100 120 140 160 1 2 3 4 5 test 1 test 2 6 test 1+2

> Multiplate® test procedures TRAPtest TRAP ADPtest Clopidogrel Prasugrel Cangrelor activation TXA2 ADP inhibition COLtest Collagen PGE1 ADPtest HS (ADP + PGE1) 1 release of arachidonic acid ArA1 TXA2 GpIIb/IIIa antagonists: Reopro ® (abciximab) Aggrastat ® (Tirofiban) Integrillin ® (Eptifibatid) COX ASPItest Arachidonic Acid Aspirin ® NSAR platelet activation GpIIb /IIIa receptor exposure degranulation :

- + PGE1 ADP Clopidogrel Activation Receptor exposure >ADPtest HS: ADP + Prostaglandin E1 PGE1 ADP Ca2+ Ca2+ Ca2+ Ca2+ Ca2+ Ca2+ Ca2+ Ca2+ cAMP Clopidogrel - + cAMP Ca2+ 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 (-). Activation Receptor exposure