An Assessment of Cardiopulmonary Bypass-Induced Changes in Platelet Function Using Whole Blood and Classical Light Transmission Aggregometry: The Results of a Pilot Study

Abstract

Whole blood and classical LTA performed with all commonly used agonists enable detection of CPB-induced changes in platelet aggregation in patients not taking antiplatelet medication, whereas in patients receiving antiplatelet therapy, ADP-induced antiplatelet assays are preferable for detecting CPB-induced impairment of platelet aggregation.

Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

“…CPB inevitably causes a hemostatic disorder and platelet function impairment. Reduction in platelet function, assessed with MEA, during and after CPB was described by Velik-Sacher et al [9]. Preoperative and intraoperative assessment of platelet function can distinguish the influence of preexisting, APT related, and CPB-acquired platelet function disorders.…”

“…Alternatively, multiple electrode aggregometry (MEA), a bedside platelet function test, may quantify platelet function in 10 minutes using tests sensitive to the effects of different antiplatelet drugs. Velik-Salcher et al demonstrated that the results of the bedside MEA and LTA did not differ in their ability to detect the effects of ASA and dual antiplatelet therapy (DAT) in patients scheduled for elective cardiac surgery [9]. The use of platelet function monitoring to guide the timing of surgery after the discontinuation of APT could be useful in terms of delaying surgery if the patient is at high risk of bleeding.…”

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

“…Previous studies have also shown that some near‐patient test results from before the start, or immediately after the end of cardiac surgery also enable prediction of postoperative bleeding 17, 18, 19, 20, 21, 22, 23. This suggests an alternative blood management strategy in which near‐patient testing is performed pre‐emptively before the highest risk period for severe bleeding in the immediate post‐operative period.…”

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

“…During CPB the soluble and circuit bound fibrin will increase the plasminogen activation 78 . The hyper-fibrinolytic state consumes fibrinogen and in addition large amounts of plasmin will affect the platelets to be less responsive to ADP and arachidonic acid (AA) 79,80 .…”

“…It is possible that more reactive platelets had adhered, and that the remaining platelets left in the samples then would show a lower reactivity. The higher degree of fibrinolysis in the IB blood might influence the ADP-and ASPI test since plasmin can reduce platelet responsiveness to ADP and arachidonic acid (AA) 79,80 . No protamine had been administrated to the patients at that time, which otherwise could influence aggregometry.…”