Early platelet recovery following cardiac surgery with cardiopulmonary bypass

Abstract

Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is frequently associated with low platelet count (PC) and disturbed platelet function (PF). While PC is easy to measure, PF is more difficult to assess. Moreover, the time-related platelet dysfunction and recovery after CPB is not fully elucidated. Platelet dysfunction could lead to bleeding but also to coronary graft failure. Laboratory tests could provide more insights into PF after CABG. The aim of the current study was to investigate the time-related PF induced by CPB. Blood samples of 20 patients with a preoperative PC of more than 250 × 10/L were collected before incision, after weaning from CPB, and 24 h postoperative. Platelet contribution to coagulation was quantified by PLTEM (calculated by means of EXTEM and FIBTEM results). PF was assessed by multiple electrode impedance aggregometry (MEIA) in whole blood and by light transmission aggregometry (LTA) in platelet-rich plasma after stimulation with arachidonic acid (AA), adenosine diphosphate, collagen, and thrombin-receptor-activating peptide. LTA and MEIA analysis demonstrated significant platelet dysfunction after CPB, with partial recovery within 24 h after surgery. AA-induced platelet aggregation increased to higher levels within 24 h after surgery compared to baseline values as measured by LTA. PLTEM maximum clot firmness remained unchanged throughout the study. Correlation analyses revealed that MEIA and rotational thromboelastometry (ROTEM), but not LTA, were dependent on PC and hematocrit. No correlations were found between LTA, MEIA, ROTEM, PC, and clinical outcome parameters. Our results demonstrate a reversible platelet dysfunction recovering within 24 h after CPB. Interestingly, AA-induced platelet aggregation increases to higher levels during the first 24 h postoperatively, which might be important for early initiation of antiplatelet therapy after CABG. MEIA as POC test is able to detect platelet dysfunction during cardiac surgery with a PC of ≥150 × 10/L.

Platelets protect lung from injury induced by systemic inflammatory response

“…Platelet count falls under certain inflammatory conditions such as during cardiopulmonary bypass 12 , and transfusion of fresh platelets can prevent bleeding after cardiopulmonary bypass. These considerations led us to wonder whether and how platelets might protect against acute pulmonary dysfunction induced by a systemic inflammatory response.…”

Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y12inhibitors

“…Assessment of platelet function before and after CPB using LTA and multiple electrode aggregometry has demonstrated that the platelet responses to TXA 2 and ADP are decreased immediately after CPB regardless of the status of preoperative platelet inhibition, or adjustments of platelet counts in test samples (as performed in LTA) [475758]. These data indicate that platelet surface TP and/or ADP receptors are temporarily less responsive to agonist stimulation when hemostasis needs to be established after CPB.…”

“…These data indicate that platelet surface TP and/or ADP receptors are temporarily less responsive to agonist stimulation when hemostasis needs to be established after CPB. Postoperatively platelet function appears to recover gradually after 3 h, and returns to normal in 24 h [5758]. …”

Heparin Coating Technology in Cardiopulmonary Bypass

“…Although the favorable side of the technology has not been proven yet, the latest researches show that the advantage of heparin coating technology is the selective attachment of plasma proteins, which can rapidly form a pseudomembrane of blood compatibility on the surface of material and, meanwhile, can prevent albuminous degeneration from enhancing the activity of attachment protein and blood cell [4]. It is also found through related researches that the plasma proteins, such as blood coagulation factor XII, fibrinogen and transparent binding protein, on the surface of artificial material can enhance the anticoagulant activity.…”