Multiple Electrode Aggregometry After Cardiopulmonary Bypass to Assess Platelet (Dys)-Function and Transfusion Threshold: A Concordance Study

Auci, Elisabetta; Vetrugno, Luigi; Riccardi, Ilaria; Brussa, Alessandro; Orso, Daniele; Baroselli, Antonio; Gigante, Andrea; Cecotti, Roberta; Bassi, Flavio; Livi, Ugolino; Bove, Tiziana

doi:10.1053/j.jvca.2020.06.060

Cited by 4 publications

(6 citation statements)

References 36 publications

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“…12,13 In the literature, it has already been shown that the ADP-test by MEA allows to optimize platelet apheresis and reduce bleeding. 9,[11][12][13] In our previous study, we highlighted how the routine use of these POCTs leads to a reduction in both the number of transfusions and the incidence of revision surgery due to postoperative bleeding. 9 Based on these studies, we updated the algorithm used in our cardiac surgery center to manage postoperative bleeding, including the routine use of the ADP-test to evaluate the need for platelet transfusion [in addition to the use of Rotational TrhomboElastr-oMetry (ROTEM) to assess global hemostasis].…”

Section: Study Assumptionsmentioning

confidence: 99%

“…12,13 In the literature, it has already been shown that the ADP-test by MEA allows to optimize platelet apheresis and reduce bleeding. 9,11-13 In our previous study, we highlighted how the routine use of these POCTs leads to a reduction in both the number of transfusions and the incidence of revision surgery due to postoperative bleeding. 9…”

Section: Introductionmentioning

confidence: 99%

“…9,11-13 In our previous study, we highlighted how the routine use of these POCTs leads to a reduction in both the number of transfusions and the incidence of revision surgery due to postoperative bleeding. 9…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated a correlation between the need for platelet concentrate transfusion and platelet dysfunction measured/detected by MEA, which is superior to the correlation obtained by means of the platelet count. [7][8][9] However, use of this technology is not very widespread in cardiac surgery centers. Current cardiac surgery guidelines provide a cut-off for transfusion of platelet concentrate based on a platelet count of less than 50 000/μL but, although there is a recommendation to monitor the platelet function when feasible, there is not yet a recommended platelets transfusion cut-off based on platelet dysfunction detected by MEA.…”

Section: Introductionmentioning

confidence: 99%

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Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study

Auci

Vendramin

Barbariol

et al. 2022

Semin Cardiothorac Vasc Anesth

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Purpose. Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. Methods. This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. Results. 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of −.2 U (95%CI of difference: −6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. Conclusion. The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.

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Section: Study Assumptionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study

Auci

Vendramin

Barbariol

et al. 2022

Semin Cardiothorac Vasc Anesth

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“…Impedance aggregometry has been demonstrated to be useful in several settings [4][5][6]. In cardiac surgery, an impedance aggregometry-based algorithm was demonstrated to reduce the requirements of blood, plasma and platelet transfusion [7][8][9]. In patients with coronary artery disease and percutaneous coronary intervention, impedance aggregometry was useful for the detection of aspirin responsiveness and resistance [10].…”

Section: Introductionmentioning

confidence: 99%

Multiplate® Platelet Aggregation Findings Are Dependent on Platelet Count but Can Be Corrected by Use of a Ratio

Soliman

Hartmann

2020

Applied Sciences

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Impedance aggregometry (Multiplate®) detects the effects of platelet aggregation inhibitors and can predict thrombotic complications after coronary and cerebrovascular stent interventions. The bedside method uses whole blood samples not corrected for platelet count. It is claimed but not proved that the findings are unrelated to platelet count in the physiological range. We therefore investigated in the experimental study: (1) whether impedance aggregometry findings and platelet count are correlated and (2) whether the aggregation/platelet count ratio expresses platelet function independent of platelet count. Following ethics committee approval, platelet-rich plasma from healthy probands was diluted with platelet-poor plasma to obtain different platelet counts. Thereafter, platelet count was measured and samples were subjected to impedance aggregometry using thrombin receptor activating peptide (TRAP) for platelet activation. In all probands, impedance aggregometry findings and platelet count were highly correlated (r = 0.88 to 0.94; p < 0.05). The combination of all experiments revealed the proportionality between impedance aggregometry findings and platelet count (n = 31, r = 0.78, p = 0.0001). In contrast, the ratio of impedance aggregometry findings and platelet count was not significantly correlated with platelet count (r = 0.017; p = 0.3) and thus constitutes a specific measure for platelet function. In conclusion, impedance aggregometry findings subsequent to the activation with TRAP are dependent on both platelet function and platelet count. Normalization of impedance aggregometry findings for platelet count can be achieved by a ratio resulting in more specific results.

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Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass: A Secondary Analysis of a Clinical Database

Hanson

Karam

Birch

et al. 2021

Pediatric Critical Care Medicine

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Multiple Electrode Aggregometry After Cardiopulmonary Bypass to Assess Platelet (Dys)-Function and Transfusion Threshold: A Concordance Study

Cited by 4 publications

References 36 publications

Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study

Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study

Multiplate® Platelet Aggregation Findings Are Dependent on Platelet Count but Can Be Corrected by Use of a Ratio

Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass: A Secondary Analysis of a Clinical Database

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