Samantha Freeman ^1,2, Mark Watson^1,3, Katherine J. Creeper^1,3

¹PathWest Laboratory Medicine, QEII, Nedlands, WA

²Department of Haematology, Perth Children’s Hospital, Nedlands, WA

³Department of Haematology, Sir Charles Gardiner Hospital, Nedlands, WA

 

Antiplatelet agents are integral to achieving good clinical outcomes for neurointerventional procedures¹. Multiple assays are available to assess the effectiveness of anti-platelet inhibition with reports of discordance between methodologies reported. Light transmission aggregometry remains the gold standard method. All tests, however, are prone to interference from pre-analytical factors^1,2.

 

We report a 43-year-old female with middle cerebral artery aneurysms requiring a flow diverter stent and post-operative antiplatelet therapy. On initial testing discordant results between thromboelastography and multiplate electrode aggregometry were noted. Further history revealed co-administration of cayenne pepper. After cessation of cayenne pepper the results demonstrated concordant response. Platelet light transmittance aggregometry was unremarkable before and after cayenne pepper cessation. Cayenne pepper contains capsaicin, which is reported to affect platelet aggregation by altering membrane fluidity and triggering calcium release³.

 

Cayenne pepper can interfere with whole blood platelet aggregation and affect different assays in different ways. Significant management decisions can be influenced by platelet function results. Appropriate history taking and counselling prior to testing will increase accuracy of platelet function studies.

 

This case has not previously been presented or published.

 

1.       Fukuda KA. Beaman C, Szeder V. Antiplatelet therapy and platelet activity testing for neurointerventional procedures. Stroke vasc. interv. neuro. 2024.

2.       Zhang W., Zhang Y., Fan J., Feng Z., Song X. Pharmacological activity of capsaicin: mechanisms and controversies. Mol. Med. Rep. 2024;29(3):1–8

3.       Maharjan, Anoth et al. A comprehensive review of capsaicin: Biosynthesis, industrial productions, processing to applications, and clinical uses. Heliyon, 2024;21(10)