Cardiopulmonary Bypass

Smith, Brian R.; Rinder, Henry M.

doi:10.1016/b978-0-12-387837-3.00052-3

Cited by 5 publications

(5 citation statements)

References 265 publications

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“…The discussion of platelet passivation of biomaterials in the context of cardiopulmonary bypass can also be found in Ref. 47. Similarly, Kang et al observed a-granule secretion in platelets adhering on peptide-coated glass surfaces only at a specific range of water contact angles (surface hydrophobicities); on the contrary, dense granule secretion did not depend on the surface properties but only on the number of the adhering platelets.…”

Section: Discussionmentioning

confidence: 95%

Differences in intracellular calcium dynamics cause differences in α-granule secretion and phosphatidylserine expression in platelets adhering on glass and TiO2

2016

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In this study, the activation of purified human platelets due to their adhesion on glass and TiO2 in the absence of extracellular calcium was investigated. Differences in α-granule secretion between platelets adhering on the two surfaces were detected by examining the expression and secretion of the α-granule markers P-selectin (CD62P) and β-thromboglobulin. Similarly, differences in the expression of phosphatidylserine (PS), and in the activation of the major integrin GPIIb/IIIa, on the surfaces of the adhering platelets, were also observed. While all of these activation markers were expressed in platelets adhering on glass, the surface markers were not expressed in platelets adhering on TiO2, and β-thromboglobulin secretion levels were substantially reduced. Differences in marker expression and secretion correlated with differences in the intracellular calcium dynamics. Calcium ionophore treatment triggered α-granule secretion and PS expression in TiO2-adhering platelets but had no effect on the activation of GPIIb/IIIa. These results demonstrate specificity in the way surfaces of artificial materials activate platelets, link differences in the intracellular calcium dynamics observed in the platelets adhering on the two surfaces to the differences in some of the platelet responses (α-granule secretion and PS expression), but also highlight the involvement of synergistic, calcium-independent pathways in platelet activation. The ability to control activation in surface-adhering platelets makes this an attractive model system for studying platelet signaling pathways and for tissue engineering applications.

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Section: Discussionmentioning

confidence: 95%

Differences in intracellular calcium dynamics cause differences in α-granule secretion and phosphatidylserine expression in platelets adhering on glass and TiO2

2016

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“…13,14 It adds to the growing body of evidence that artificial surfaces exhibit properties that are similar to those of classical platelet agonists, and that responses of platelets to different surfaces are different. 20,21,[23][24][25][26] Most likely, the surface-platelet signaling is mediated by the adsorbed proteins. 27,28 Properly studied, these phenomena offer a possibility to improve the control over the response of platelets to artificial surfaces.…”

Section: Resultsmentioning

confidence: 99%

Subpopulations in purified platelets adhering on glass

2016

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Understanding how platelet activation is regulated is important in the context of cardiovascular disorders and their management with antiplatelet therapy. Recent evidence points to different platelet subpopulations performing different functions. In particular, procoagulant and aggregating subpopulations have been reported in the literature in platelets treated with the GPVI agonists. How the formation of platelet subpopulations upon activation is regulated remains unclear. Here, it is shown that procoagulant and aggregating platelet subpopulations arise spontaneously upon adhesion of purified platelets on clean glass surfaces. Calcium ionophore treatment of the adhering platelets resulted in one platelet population expressing both the procoagulant and the adherent population markers phosphatidylserine and the activated form of GPIIb/IIIa, while all of the platelets expressed CD62P independently of the ionophore treatment. Therefore, all platelets have the capacity to express all three activation markers. It is concluded that platelet subpopulations observed in various studies reflect the dynamics of the platelet activation process.

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“…In this study, we found that platelet dysfunction, as measured by response to collagen near the end of bypass, was independently associated with adverse postoperative outcomes. The milieu of haemostatic activation; elevated thrombin and plasmin levels; complement activation; contact with foreign materials (bypass circuit, cannulas); and interaction with circuit‐adhered immune cells, such as neutrophils, leading to platelet activation , could all lead to dysregulation of platelet surface proteins (gycoproteins, p‐selectin, CD31) and abnormal aggregation .…”

Section: Discussionmentioning

confidence: 99%

“…The safe use of cardiopulmonary bypass during surgery requires profound anticoagulation to prevent haemostatic activation resulting from contact between blood and the bypass circuit . Despite anticoagulation, the conduct of bypass results in varying levels of haemostatic activation characterised by upregulation of thrombin, consumption of coagulation factors and platelet dysfunction . This haemostatic activation can lead to peri‐operative coagulopathy or, paradoxically, postoperative thromboembolic complications such as acute kidney injury, stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism .…”

Section: Introductionmentioning

confidence: 99%

“…An important consequence of bypass‐related haemostatic activation is platelet dysfunction leading to ineffective platelet agonist‐mediated activation, aggregation and sequestration . We hypothesised that platelet dysfunction, as measured by a point‐of‐care assay during bypass, may be associated with postoperative prothrombotic adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The association between platelet dysfunction and adverse outcomes in cardiac surgical patients

Lenihan

McVey

et al. 2019

Anaesthesia

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Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypassassociated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.

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Cardiopulmonary Bypass

Cited by 5 publications

References 265 publications

Differences in intracellular calcium dynamics cause differences in α-granule secretion and phosphatidylserine expression in platelets adhering on glass and TiO2

Differences in intracellular calcium dynamics cause differences in α-granule secretion and phosphatidylserine expression in platelets adhering on glass and TiO2

Subpopulations in purified platelets adhering on glass

The association between platelet dysfunction and adverse outcomes in cardiac surgical patients

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