Modified thromboelastography evaluation of platelet dysfunction in patients undergoing coronary artery surgery

Abstract

TEG with platelet mapping is able to predict excessive postoperative blood loss among patients who underwent CABG and recent anti-platelet therapy. The prevalence of non-responsiveness to anti-platelet therapy, including clopidogrel, is higher in patients undergoing coronary artery bypass grafting than in the general population. In this study, aspirin-induced platelet dysfunction did not influence postoperative blood loss.

Platelet mapping as part of modified thromboelastography (TEG®) in patients undergoing cardiac surgery and cardiopulmonary bypass

“…We did not find a difference in bleeding rates associated with aspirin use; however, our study was not designed or powered to examine this question. Previous studies have reported no increase in post-CPB bleeding related to aspirin [23,31,32], while others have demonstrated a trend to increased blood product usage in aspirin-treated patients [33]. It seems that the evidence implicating early graft occlusion following coronary artery surgery due to platelet hyper-reactivity favours keeping patients on aspirin if they were already on it [34][35][36][37], hence in agreement with our cardiac surgeons we elected to enrol these patients.…”

“…Preisman et al examined the role of pre-operative platelet mapping in predicting bleeding tendency in patients on recent anti-platelet therapy (aspirin alone or aspirin and clopidogrel) undergoing coronary artery bypass surgery [23]. In this setting, clopidogrel-induced platelet dysfunction using ADP was able to differentiate between patients with or without excessive bleeding.…”

“…These results have demonstrated that the percentage platelet aggregation measurement for collagen was able to predict patients at risk for increased postoperative blood loss when performed in either the pre-or post-CPB setting. The causes of postoperative bleeding following CPB are multifactorial, and the need for blood transfusion confers significant risk to the patient [22,23]. Postoperative bleeding has been associated with increased reexploration rates, sepsis, renal failure, respiratory failure and prolonged ICU stay [24,25].…”

Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

“…Although revealed with different assay, study described the same phenomenon as we did. Using modified TEG with arachidonic acid as platelet agonist Preisman S et al showed 44% rate of non-responsiveness to aspirin [32]. Using the turbidimetric method for platelet aggregation measuring, Kempfert et al reported 28.8% patients with RPR before CABG.…”

Coagulation Crystal Ball

“…1,5,7 Both standard hemostatic assessments (e.g., prothrombin time, fibrinogen concentration) and viscoelastic measurements of hemostasis (e.g., thromboelastometry, thrombelastography) have been used separately and in combination to predict post-CPB bleeding. [1][2][3]7,8 However, the tacit assumption that these laboratory methods could measure changes in plasmatic/platelet-mediated hemostasis that could be linked to remote bleeding events has not been supported.…”