New Test Tells Doctors Whether Blood Thinners Are Actually Working

BIDMC-Developed Assay Could Help Clinicians Personalize Treatment for Patients on Antiplatelet Medications

BOSTON — Researchers at Beth Israel Deaconess Medical Center (BIDMC) have developed a new laboratory test that could make it easier for doctors to tell whether blood-thinning medications are working. The test could serve as a solution for a longstanding challenge in caring for patients at risk for heart attack and stroke.

The test, described in a study published in Blood, works by reading a signal produced by platelets, the small blood cells responsible for clotting, when they respond to medication. A protein inside platelets called Drp1 changes in a predictable way depending on whether those cells are being activated or suppressed. By measuring that change, researchers can tell whether a clot‑preventing medication is doing its job to prevent dangerous clots that can cause heart attacks and strokes.

“This project grew out of basic research on how platelets regulate their internal signaling networks,” said Robert Flaumenhaft, MD, PhD, professor of medicine and chief of the Division of Hemostasis and Thrombosis at BIDMC. “By understanding these pathways in detail, we were able to design a lab test that works as a tool both for basic science and for clinical testing.”

Cardiovascular disease remains the leading cause of death in the United States, and antiplatelet medications are among the most prescribed therapies in medicine, taken by millions of patients after a heart attack, stroke, or coronary procedure to prevent a recurrence. But currently, there's no easy way to know if most of these medications are actually working. The tests that can answer that question are too complex or costly for routine use.

The Drp1 test is designed to run on standard equipment already present in most hospital laboratories, using ordinary blood samples that can be frozen and processed in batches.

In the study, Flaumenhaft and colleagues tested the assay, developed through a collaboration between BIDMC and PlateletDiagnostics, LLC, a company co-founded by BIDMC investigators, in healthy volunteers taking the blood-thinning medications aspirin and clopidogrel. They found that the test accurately determined whether the drugs were working, and that it performed at least as well as, and in some cases better than, current gold-standard tests.

“For years, detailed knowledge of cell signaling has driven drug development, but that same knowledge has rarely been applied to diagnostics," said Flaumenhaft. "What this study shows is that the detailed molecular changes happening inside blood cells can serve as precise, readable signals. This same approach could potentially be used to assess dozens of antiplatelet drugs and platelet disorders."

Co-authors included David A. Barrios, Shihui Guo, Secil Koseoglu, Somal Khan, Sabrina Zerbey, Roosevelt Lu, Alexander Cermak, Arielle Urman, Joseph Thomas, and Rushad Patell of BIDMC; Matthew Powers and Omozuanvbo Aisiku of PlateletDiagnostics; Caroline Vayne of Regional University Hospital Centre Tours; and Jeffrey I. Zwicker of Weill Cornell Medical College. 

This work was supported by PlateletDiagnostics, LLC; the National Institutes of Health (grants U54HL11914, R41 HL150951-01A1); and Boston Medical Innovation Center, B-BIC.

Disclosure: The technology described in this article has been licensed to PlateletDiagnostics, LLC, a company co-founded by investigators at BIDMC, including the corresponding author. This relationship has been reviewed and managed in accordance with BIDMC's conflict of interest policies.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.