Table 3

Phenotypic biomarkers

AssaysSamplePrinciple of assayMeasurement methodAnalytical validity† (range)Biological validityClinical validityClinical utility
LTA Platelet-rich plasma ADP-induced platelet aggregation Light absorbance CV = 3.3-11.3% † Low-quality evidence ‡ 
VerifyNow P2Y12 Whole blood ADP-induced platelet aggregation (with PGE1 modulation) Light absorbance CV = 6-7.5%, r = 0.35-0.86 † Moderate-quality evidence ‡ 
k = 0.2-0.82 
Multiplate electrode aggregometry (MEA) Whole blood ADP-induced platelet aggregation Electrical impedance CV = 5-10% † Low-quality evidence ‡ 
r = 0.25-0.87 
k = 0.1-0.7 
PFA-100 (INNOVANCE P2Y) Whole blood Shear-dependent ADP-induced platelet adhesion and aggregation Closure time: Time for platelet plug to stop blood flow across aperture CV = 7.7-9.5% † Low-quality evidence ‡ 
r = −0.7 to −0.11 
k = 0.14-0.35 
Thromboelastography (Haemoscope TEG) Whole blood Kinetic changes with ADP- induced clot formation Tensile strength of clot CV = 4.5-6.6% † Insufficient evidence ‡ 
r = 0.32-0.82 
k = −0.02 to 0.81 
Vasodilator stimulatory protein assay (VASP) Whole blood ADP-induced P2Y12 receptor activation–dependent phosphorylation Flow cytometry to quantify VASP phosphorylation CV = 2.3-6.6% † Low-quality evidence ‡ 
r = 0.36-0.72 
k = −0.04-0.31 
AssaysSamplePrinciple of assayMeasurement methodAnalytical validity† (range)Biological validityClinical validityClinical utility
LTA Platelet-rich plasma ADP-induced platelet aggregation Light absorbance CV = 3.3-11.3% † Low-quality evidence ‡ 
VerifyNow P2Y12 Whole blood ADP-induced platelet aggregation (with PGE1 modulation) Light absorbance CV = 6-7.5%, r = 0.35-0.86 † Moderate-quality evidence ‡ 
k = 0.2-0.82 
Multiplate electrode aggregometry (MEA) Whole blood ADP-induced platelet aggregation Electrical impedance CV = 5-10% † Low-quality evidence ‡ 
r = 0.25-0.87 
k = 0.1-0.7 
PFA-100 (INNOVANCE P2Y) Whole blood Shear-dependent ADP-induced platelet adhesion and aggregation Closure time: Time for platelet plug to stop blood flow across aperture CV = 7.7-9.5% † Low-quality evidence ‡ 
r = −0.7 to −0.11 
k = 0.14-0.35 
Thromboelastography (Haemoscope TEG) Whole blood Kinetic changes with ADP- induced clot formation Tensile strength of clot CV = 4.5-6.6% † Insufficient evidence ‡ 
r = 0.32-0.82 
k = −0.02 to 0.81 
Vasodilator stimulatory protein assay (VASP) Whole blood ADP-induced P2Y12 receptor activation–dependent phosphorylation Flow cytometry to quantify VASP phosphorylation CV = 2.3-6.6% † Low-quality evidence ‡ 
r = 0.36-0.72 
k = −0.04-0.31 

k, κ statistics; PGE1, prostaglandin E1; r, correlation coefficient.

*

CV refers to intra-assay coefficient of variation; measures of test agreement (k) and correlation (r) refer to the comparison of given test with LTA.

†

All measure consequences of ADP-induced platelet activation.

‡

Insufficient evidence to prove or disprove clinical utility of a biomarker strategy.

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