Assessment of Platelet Inhibition Secondary to Antiplatelet Therapy using A Point-of-Care TEG-PM Device

Year Submitted: 2025
Published Date: 06 January 2026

Tags: Training ＆ Education, Education Research

About this Content

Aims

1) To determine the level of anti-platelet resistance in our local population with
Intracerebral Haemorrhage (ICH).
2) To determine the effectiveness of anti-platelet reversal with platelet transfusion
in a local population with ICH.

Background

Currently, all patients admitted to NICU with ICH and on antiplatelet therapy will be
routinely given platelet transfusion without assessment of platelet function, regardless of
whether patients are scheduled for emergency clot evacuation or conservatively managed
in the ICU. Platelet Transfusion therapy has its associated risk, such as hemolytic reactions,
transfusion-related acute lung injury and infectious disease transmission etc.
The Thromboelastography-Platelet Mapping (TEG-PM) is designed to assess platelet
inhibition secondary to antiplatelet therapy. It has been used to assess platelet function
perioperatively and intraoperatively in patients presenting for elective surgery with
antiplatelet therapy and also for efficacy of antiplatelet therapy in patients with Acute
Coronary Syndromes (ACS).
Currently, there is no data with regards to platelet functionality for our local population on
antiplatelet therapy in the context of an acute intracranial haemorrhage event.

Methods

A prospective observational study was conducted on patients who were admitted
to NICU from August 2022 to December 2023 and consented to participate in the
study. The patients were categorized into those on antiplatelet therapy (aspirin or
clopidogrel prior to admission) and those without (control group). Patients on
anticoagulants were excluded. TEG-PM was performed within 6 hours after
symptom onset and repeated within 1 hour in those patients who received platelet
transfusion. The clinicians were blinded to the TEG-PM results and the results were
not used to determine the need for platelet transfusion.
The patient clinical characteristics, TEG-PM results, clot volume from CT scan and
ICU outcomes were compared between the 2 groups.

Results

1) The study team observed a total of 8 participants who received platelet
transfusion out of 45 recruited, of which 2 of the transfusion could have
been avoided -- if the clinical team were to use POCT TEG-PM test.
2) The cost of 1 packet of pooled platelet (non-subsidized) is $513.45.
However, the manpower required to place order and administer the blood
product as well as the risk of blood transfusion were difficult to measure.

Conclusion

TEG-platelet mapping is able to detect platelet inhibition in South East Asian Patients with
spontaneous ICH on antiplatelet therapy. However, the overlap in platelet inhibition values
between the antiplatelet and control group may confound its clinical usefulness and
defining suitable transfusion thresholds. This warrants further investigation.

Lessons Learnt

A final analysis was performed in Oct 2023 and the finding showed that TEG-PM is
able to detect platelet inhibition in patients with spontaneous ICH on antiplatelet
therapy. The patients on antiplatelet had higher mean arachidonic acid (AA) and
adenosine diphosphate (ADP) inhibition than controls and are statistically
significant (P less than 0.05). There is a trend towards a lower maximum amplitude (MA) in
the antiplatelet group compared to the control group but this did not reach
statistical significance. More data in a larger population is required before a clinical
protocol can be developed.

Additional Information

Funded by NTFHIP.

Keywords

Point-of-Care Test, TEG-PM, Thromboelastography-Platelet mapping, Platelet inhibition

Innovators' Details

Connect with this contributor!

Wong Yu-Lin - yu.lin.wong@nhghealth.com.sg

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