Consensus recommendations for using the Multiplate^® for platelet function monitoring before cardiac surgery

Abstract

Summary Patients requiring urgent cardiac surgery are usually already taking antiplatelet drugs including aspirin and a P2Y12 ADP receptor antagonist (e.g., clopidogrel, prasugrel or ticagrelor). This presents clinicians with the challenge of balancing the risk of thrombotic complications, if antiplatelet drugs are stopped before surgery, with the problems of excessive bleeding when surgery is performed in the absence of adequate platelet function. Preoperative platelet function monitoring is able to identify when patients have recovered platelet function. The Multiplate® (multiple electrode impedance platelet aggregometer) is a point of care device that enables monitoring of platelet function. The authors offer recommendations based on real‐world, collective experience in the use of platelet function monitoring. These cover the use of the Multiplate® analyser to predict the need for platelet transfusion in the perioperative period and the individualized waiting period after cessation of P2Y12 ADP receptor antagonists before cardiac surgery.

<p>Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model</p>

“…However, pre-operative platelet function testing may guide decision-making regarding proceeding or cancelling surgery where possible. [52][53][54] Participants uniformly identified access to point of care diagnostic assays was critical to improving bleeding management; with access (or lack of) these instruments reflecting resource issues but also issues of support (or lack of) from external disciplines and departments (haematology, blood bank).…”

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

“…91 Conversely, a recent position statement has recommended routine Multiplate use in patients receiving P2Y 12 receptor antagonists. 92 To address this uncertainty we assessed the predictive accuracy of routine preoperative platelet function tests in the COPTIC A study.…”

“…This contrasts with the recommendations of established blood management guidelines in cardiac surgery 24 and a recent consensus statement from UK researchers recommending routine preoperative platelet function testing. 92 Corredor et al 25 reviewed studies that had considered the predictive accuracy of preoperative platelet function testing in cardiac surgery. The evidence for preoperative testing was inconsistent and positive studies considered only patients receiving P2Y 12 receptor blockers.…”

Haemostatic management of cardiac surgical haemorrhage

“…Point-of-care devices such as Multiplate (Roche Ltd) for assessing platelet function using are now available. The evidence for their benefit is limited [27][28][29] and thresholds for intervention are not yet clearly defined. However, abnormal results for the stimulation of the adenosine diphosphate (ADP) and thrombin receptors (residual aspirin and clopidogrel activity respectively) may be predictive for higher transfusion requirements [30].…”