A laboratory association between hemoglobin and VerifyNow P2Y12 reaction unit: A systematic review and meta-analysis

Yun Gi Kim, Jung Won Suh, Dirk Sibbing, Adnan Kastrati, Young Guk Ko, Yangsoo Jang, Young Seok Cho, Tae Jin Youn, In Ho Chae, Dong Ju Choi, Hyo Soo Kim

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background VerifyNow P2Y12 assay is used widely to evaluate residual platelet reactivity in patients taking P2Y12 receptor antagonists. However, a laboratory association between VerifyNow P2Y12 reaction unit (PRU) and hemoglobin, which might lead to wrong interpretation of the data, is reported. We performed these systematic review and meta-analysis to clearly define the relationship between PRU and hemoglobin and to elucidate whether the relationship, if any, is a true biological association or is just a laboratory error. Methods Through a comprehensive electronic and manual search, 10 studies were selected for the cohort level meta-analysis. Among 10 studies, we were able to retrieve the raw data of 5 studies, and a patient-level meta-analysis was performed. Potential publication bias was searched by funnel plot analysis and was actively adjusted, if present, by trim and fill method. Results The pooled analysis revealed a significant inverse correlation between PRU and hemoglobin (r = −0.349; P < .001; 10 studies with 4,793 patients). VerifyNow P2Y12 base unit, which reflects off-drug platelet reactivity, was also inversely correlated with hemoglobin (r = −0.526; P < .001; 8 studies with 4,395 patients). % Inhibition (r = 0.081; P = .059; 6 studies with 3,832 patients) and ΔPRU (r = −0.037; P = .188; 5 studies with 3,521 patients) were not associated with hemoglobin. A significant inverse association between PRU and hemoglobin was also observed in the patient-level meta-analysis (3,533 patients pooled from 5 studies; r = −0.335; P < .001). Light transmission aggregometry (r = 0.160; P = .072; 4 studies with 1,144 patients) and multiple electrode platelet aggregometry (r = −0.029; P = .394; 3 studies with 7,645 patients) showed no significant association with hemoglobin. Conclusions A significant inverse association was observed between PRU and hemoglobin which is likely to be a laboratory error. Clinicians should be aware that this association might lead to wrong interpretation of the data.

Original languageEnglish
Pages (from-to)53-64
Number of pages12
JournalAmerican heart journal
Publication statusPublished - 2017 Jun 1

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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