Background: Antiplatelet therapy is commonly used in children to prevent thrombotic vascular complications. While numerous clinical trials in adults have performed for assessment of platelet reactivity on dual antiplatelet therapy (DAPT), less is known about the assessment of platelet reactivity on DAPT in children.

Aims: To evaluate platelet aggregation using MEA in pediatric patient after stent implantation of ductus arteriosus to confirm the antithrombotic efficacy.

Methods: We presented a case of 4-month baby with pulmonary valve atresia successfully managed with ductal stenting. A male baby with weight of 5.220 kg received clopidogrel 1 mg/d (0.2 mg/kg/d) and aspirin 30 mg/d (5 mg/kg/d) from 4 months. We performed assessment of antiplatelet therapy with Multiplate impedance aggregometry (MEA) by ADP and ASPI tests.

Results: We found optimal platelet inhibition at 4 months therapy: ADP-test 28 U (optimal inhibition at 15-45 U for adults) on clopidogrel therapy and ASPI- test 21 U (optimal inhibition at 4-30 U for adults) on aspirin therapy. Re-examination after 1 month showed also platelet inhibition in therapeutic range: ADP-test 20 U, ASPI- test 22 U. Follow-up treatment was without thrombotic or bleeding complications.

Conclusions: We evaluated platelet reactivity using MEA, based on our previous experience in adults groups to confirm the efficacy of antiplatelet therapy. Assessment of platelet inhibition is rarely performed in populations of neonates and children. Further validation in trials is necessary to determine the most appropriate threshold values for pediatric populations.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/evaluation-of-platelet-reactivity-in-pediatric-patient-on-dual-antiplatelet-therapy-after-stent-implantation-of-ductus-arteriosus-a-case-report/