VerifyNow

Reference Guide
Interventional Procedure
Patients with inadequate response to their antiplatelet medications
may be at significantly greater risk of myocardial infarction, stent
thrombosis and death. Patients with hyper response to their
antiplatelet medications may be at risk of bleeding.1-4

Up to 40% of patients on a ntiplatelet medications may not receive the

expected platelet inhibiting effect.5

Numerous factors may causeinadequate response,6 including:

• Drug Interactions • Pre-existing health
(e.g. proton pump inhibitors) conditions (e.g. diabetes)
• Genetic differences • Non-compliance

Percent Inhibition from pre and post drug assays

Decrease in Drug Effect Over Time
14

100 100
100 96.2
% of Subjects Returning to Baseline PRU

88.5
90
80.8
77.8
80
70
60 53.8 55.6
50
40 37
30.8
30
20
10
0
1 3 5 6 7 9
Washout Day
Clopidogrel Prasugrel
VerifyNow PRUTest Results: What is Reported?
The lab report may look similar to the following:

**********************************************************

Patient Example Reference Range

PRUTest Results Patient A Units (off drug)
P2Y12 Reaction Units 132 PRU 194–418

Values less than 194 PRU are specific evidence of a P2Y12

inhibitor effect.

**********************************************************

Patient Response to Antiplatelet Therapy14

350

300 Normal platelet

NO DRUG EFFECT reactivity due to
250 low P2Y12
inhibition response
200

150 Decreased platelet

reactivity due to
DRUG EFFECT
100 the effect of a
P2Y12 inhibitor
50
VerifyNow PRUTest Results
To Order This Test:

VerifyNow PRUTest:
Platelet response to P2Y12 inhibitors (e.g clopidogrel, prasugrel,
and ticagrelor).

PRU (P2Y12 Reaction Units)

• ADP induced aggregation­— extent of platelet aggregation in the
presence of P2Y12 inhibitors.
• Measures the On-Treatment Platelet Reactivity (OTPR) of ADP
P2Y12 receptor.

Pre-Surgical Application
• Studies show that there is patient variability in response to P2Y12
inhibitors7.
• Patients that have been administered P2Y12 inhibitors such as
clopidogrel and prasugrel are at risk of perioperative bleeding due
to platelet dysfunction from drug effect.
• It has been recommended to discontinue P2Y12 inhibitors for 5 – 7
days prior to surgery8 for platelet function to be restored9, however,
2012 STS Guidelines10 recommend using platelet function testing to
aid in timing of surgery, instead of arbitrarily waiting a pre-specified
period of time.

Conditions that May Affect Test Results

• Patient’s exposure to GP IIb/IIIa inhibitors within 48 hours of
eptifibatide (Integrilin®) or tirofiban (Aggrastat ®), or 14 days of
abciximab (ReoPro®).
• Improper sample collection.
VerifyNow Aspirin Results
To Order This Test:

VerifyNow Aspirin Test:

Platelet response to aspirin.

Result Interpretation:
≤ 549: Evidence of platelet dysfunction due to aspirin.
> 550: No evidence of aspirin-induced platelet dysfunction.

ARU (Aspirin Reaction Units)

Arachidonic acid induced aggregation.

Post-Aspirin Ingestion14

700 No evidence
650
of aspirin-
NO DRUG EFFECT induced
600 platelet
dysfunction
550

500 Evidence
of platelet
450 DRUG EFFECT dysfunction
due to
400
aspirin
350

Post-Aspirin Ingestion
How It Works: Activates Specific Drug Receptor Sites
Receptor Blockade

VerifyNow
• Measures the P2Y12 PRUTest
platelet receptor
ADP (P2Y12)
blockade. Assesses
patient response to
antiplatelet therapy
including clopidogrel
(Plavix®), prasugrel
(Effient®) and
ticagrelor (Brilinta®). AA

• Measures the platelet TXA2 Thromboxane A2

response to aspirin by
VerifyNow
an arachidonic acid Aspirin Test
initiated reaction.
GP IIb/IIIa

• Measures the patient VerifyNow

response to IIb/IIIa IIb/IIIa Test

inhibitors such
as eptifibatide
(Integrilin®) and
abciximab (ReoPro®).

Blood Sample Blood Sample

Showing Inhibition of Showing Normal
Platelet Function Platelet Function
Agonist

Red Blood Cells

Fibrinogen-Coated Beads
Platelet-Bead
Platelets Aggregates

Low Light Increased Light

Transmittance Transmittance
VerifyNow Aspirin or PRUTest Sample Collection Procedure
Direct Venipuncture
1 Sample collection directly
1 5 mlinto vacuum collection tubes

1. Use 2 mL Greiner Bio-One partial-fill vacuette tubes with 3.2%

sodium citrate (blue top). Greiner #454322.
2 1 2
2. Collect 2 tubes2 of whole blood using a 21 gauge or larger
needle. First, collect a discard tube (at least 2 mL) making
sure the discard tube does not contain any platelet inhibiting
3 2 substance (e.g.3 EDTA).
1 Butterfly (21 gauge) is OK to use.

CBC
3. Fill the second tube (sample tube) to the black line (1/2 tube).
Do not under fill. Discard the first tube. Keep the second tube
4 2 for testing. 4 X5
CBC

4. If drawing blood for a CBC at the same time, fill the CBC
tube last.
5 X5 5. Gently invert the
5
tube at least 5 times to ensure complete
mixing of the contents. Samples with evidence of clotting
should not be used. Do not shake, as that may give
incorrect results.
6
6. Label the tube with the patient ID, date and time it was drawn.
Do not refrigerate. Do not put in pneumatic tube system.

Indwelling Catheter
1 5 ml
1. Discard the first 5 mL from an indwelling catheter to clear the
line. Ensure the catheter is free of clots.
2. Immediately transfer blood to a 2 mL Greiner Bio-One partial-
2
fill vacuette tube with 3.2% sodium citrate (blue top). Greiner
#454322. Fill to the black line (1/2 tube). Do not under fill.
3. If drawing blood for a CBC at the same time, fill the CBC
3 1
CBC

tube last.
4. Gently invert the tube at least 5 times to ensure complete
mixing of the contents. Samples with evidence of clotting
4 X5 should not be used. Do not shake, as that may give
incorrect results.
5. Label the tube with the patient ID, date and time it was drawn.
5 Do not refrigerate. Do not put in pneumatic tube system.
 Medication(s)

Dose Given

Test Timing
Suggested
VerifyNow

Incubation

(Minutes)
Run Time
(Minutes)
Sample
Tested
Test

75 mg ≥ 7 days on maintenance1
Clopidogrel
300 mg ≥ 8 hours post bolus2
(Plavix®)
600 mg ≥ 6 hours post bolus3
5 mg ≥ 5 days on maintenance11
Prasugrel
10 mg ≥ 5 days on maintenance11
(Effient®)
PRUTest

60 mg ≥ 45 minutes post bolus9 10 ~3

≥ 1 day on maintenance7
90 mg (bid) (within 8 hours of last
dose for maximal effect)
Ticagrelor
(Brilinta®)
≥ 2 hours post bolus8
180 mg (within 8 hours for
maximal effect)
Aspirin Aspirin 81–325 mg ≥ 2 hours post dose 30 ~5

For more details, see the VerifyNow Test package insert.

1 Plavix (clopidogrel bisulfate) tablets Prescribing Information. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. 3/2010
Update. 2 Price, MJ et al. Am J Cardiol 2006;98:681-684. 3 Hochholzer W. et al. Circulation. 2005;111:2560-2564. 4 Ticlid (ticlopidine
hydrochloride) tablets Prescribing Information. Roche Laboratories Inc. Revised 12/2005. 5 ADAPT DES. The Lancet, Volume 382,
Issue 9892, Pages 614 - 623, August 17, 2013. 6 VerifyNow IIb/IIIa Test Package Insert. 14320.K. 2009-06-10. 7 Increased Active
Metabolite Formation Explains the Greater Platelet Inhibition With Prasugrel Compared to High-dose Clopidogrel. June 26,
2007 8 Husted S et al. Eur Heart J. 2006;27:1038–1047 9 Brilinta (ticagrelor) tablets prescribing information. AstraZeneca group of
companies. July 20, 2011. 10 2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients
having Cardiac and Noncardiac Operations. © 2012 by the Society of Thoracic Surgeons. Published by Elsevier Inc. 11 Breet, NJ. et
al. J Thromb Haemost 2010 Oct;8(10):2140-8. 12 Breet, NJ. et al. Heart 2011 Jun;97(12):983-90. 13 Jimenez, AH. et al. Am J Cardiol.
14 VerifyNow Aspirin Test [package insert]. San Diego, CA; Accumetrics®; Revised April 2011.

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