Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Showalter, Josh; Nguyen, Nghia D.; Baba, Samer; Lee, Chi Hyun; Ning, Jing; Klein, Kimberly; Wahed, M. A.; Tholpady, Ashok

doi:10.1002/jcla.22084

Cited by 3 publications

(4 citation statements)

References 10 publications

(16 reference statements)

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“…Our results are further replicated by Showalter et al who found no reduction in platelet aggregation in heart failure patients with reduced kidney function compared with heart failure patients with normal kidney function. 108 In the non-ICU studies of our systematic review, AKI was often associated with lower platelet counts compared with non-AKI patients. However, the timing between blood sampling and AKI diagnosis was unclear in some studies, 59,62,92 rendering the causal relationship between AKI and platelet count indiscernible.…”

Section: Discussionmentioning

confidence: 84%

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Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study

Jensen

Hviid

Hvas

et al. 2022

Semin Thromb Hemost

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Acute kidney injury (AKI) patients have increased bleeding risk, which could be partially due to acquired platelet dysfunction. We conducted a systematic review and a cohort study to investigate platelet function and count in AKI and their association with AKI-related bleeding and mortality. Through a systematic literature search in PubMed and Embase, we identified 9 studies reporting platelet function and 56 studies reporting platelet count or platelet indices in AKI patients. Overall, platelet aggregation was reduced in AKI patients in nonintensive care unit (ICU) settings but not in ICU settings, except that reduced aggregation was associated with renal replacement therapy. Thrombocytopenia in AKI was frequent and often predictive of mortality. In our cohort study, we prospectively included 54 adult ICU patients who developed AKI within 24 hours of ICU admission and 33 non-AKI ICU controls. Platelet function was measured with light transmission aggregometry and flow cytometry. AKI patients bled more frequently than non-AKI patients (p = 0.04), and bleeding was associated with increased 30-day mortality in AKI (p = 0.02). However, platelet function was not different between AKI and non-AKI patients (aggregation: all p > 0.52; flow cytometry: all p > 0.07) and platelet function was not associated with bleeding in AKI. In conclusion, a reduced platelet count is frequent in AKI, but the literature on platelet function in AKI is sparse. In a cohort study, we demonstrated that patients with AKI within 24 hours of ICU admission exhibited increased bleeding tendency but this was not associated with reduced platelet function.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study

Jensen

Hviid

Hvas

et al. 2022

Semin Thromb Hemost

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“…Furthermore, most of our patients were on any anti-platelet medication or anti-coagulated with LMWH or oral anticoagulation. This could have resulted in decreased responses to agonists in the Mutiplate R measurements (40) before LVAD implantation and also subsequently. Particularly, P 2 Y 12 inhibition exerts thereby a degree of PAR-1 inhibition (41).…”

Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study on Multiplate®-, ROTEM®- and Thrombin Generation Examinations Before and Early After Implantation of a Left Ventricular Assist Device (LVAD)

et al. 2022

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BackgroundHeart failure patients are frequently on coagulation-active medications before LVAD implantation and perioperative bleeding is a frequent complication after left ventricular assist device (LVAD) implantation. The role of point-of-care coagulation tests in assessing bleeding risk for LVAD implantation and the early postoperative time course of these tests is not well established.MethodsWe prospectively enrolled 25 patients with terminal heart failure undergoing LVAD implantation. Study related TRAP-, ASPI- and ADP- tests of Multiplate® platelet aggregometry, ROTEM® rotational thromboelastometry (INTEM, EXTEM, FIBTEM), thrombin generation assay and conventional laboratory studies were measured at 11 predefined time-points during the first 21 postoperative days. We examined if preoperative TRAP-, ASPI-, ADP- and ROTEM values are correlated with estimated total blood loss (primary outcome parameter) during the first 21 days after LVAD implantation and compared the baseline values of these measurements between patients with a bleeding event to those without. We performed Spearman's correlation and non-parametric tests for paired and non-paired comparisons.Results7 out of 25 (28%) patients experienced a bleeding event of which 4 required surgical revision. Of the preoperatively performed measurements the TRAP test [Spearman's Rho (ρ) = −0.5, p = 0.01], INTEM CFT (ρ = 0.72, p < 0.001), INTEM alpha (−0.7, p < 0.001), EXTEM MCF (ρ = −0.63; p < 0.001), EXTEM alpha (ρ = −0.67; p < 0.001), FIBTEM MCF (ρ = −0.41; p = 0.042), Fibrinogen (Clauss) (ρ = −0.5; p = 0.011), Anti-thrombin activity (ρ = −0.49; p = 0.013) and platelet count (ρ = −0.42; p = 0.034) were significantly correlated to total blood loss. Patients undergoing a surgical bleeding revision had significantly reduced values in TRAP—[31.5 IQR (17.25–43.5U) vs. 69 IQR (52.5–87U); p = 0.004], ASPI—[16.5 IQR (5.5–35.7U) vs. 39 IQR (24.5–62.5U); p = 0.038], ADP—[30 IQR (22–69U) vs. 12.5 IQR (8.7–21.5U); p = 0.01], EXTEM MCF—[63 IQR (57.7–63.7) vs. 67 IQR (65–75.5); p = 0.019] and EXTEM alpha [74 IQR (68.75–74) vs. 79 IQR (78–80.5); p = 0.002] values before LVAD implantation.ConclusionMultiplate® and ROTEM® measurements before LVAD implantation may identify LVAD candidates with platelet dysfunction and alterations of the primary hemostasis and could guide anesthetists and intensive care practitioners in bleeding risk stratification and in the perioperative clinical management.

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“…Desmopressin acetate has been shown to reduce bleeding time in uremic patients by releasing vWF and factor VIII into plasma, taking effect within 1 hour and lasting 4 to 8 hours. [25][26][27] Desmopressin has also been shown to reduce blood loss and bleeding times in patients with platelet dysfunction undergoing cardiac surgery. 28 While the underlying mechanism is unclear, desmopressin acetate is thought to help with platelet adhesion to the endothelial wall.…”

Section: Desmopressinmentioning

confidence: 99%

Vascular Access Emergencies in the Dialysis Patient

Sweat¹,

Clare²,

Evans³

2017

Emerg Med

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A ccording to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 468,000 persons in the United States are on dialysis-a number that continues to grow annually. 1 The 1-year rate for hemorrhagic complications from arteriovenous fistulas (AVFs) is estimated to be 0.4%. 2 One study by Ellingson et al 3 reported 1,654 deaths secondary to fatal vascular access hemorrhage over a 6-year period, accounting for 0.4% of all deaths of hemodialysis (HD) patients in that study. 3 Nonhemorrhagic vascular access-related complications also contribute to the morbidity and mortality associated with AVFs and arteriovenous grafts (AVGs). Venous stenosis resulting in thrombosis has been estimated to occur in 24.7% of AVGs and 9.0% of AVFs, both of which are common causes of access failure. Infection is reported to be the second leading cause of death in dialysis patients, and vascular access-related infection rates are reported to occur in 9.5% of AVGs vs 0.4% to 0.9% of AVFs. 2,4 Pseudoaneurysms and aneurysms range from 30% to 60% for AVFs, 2,5 and contribute to morbidity by limiting available areas to cannulate for dialysis, occasionally requiring surgical revision to restore access function or prevent access rupture. Steal phenomena, including dialysis access-induced steal syndrome (DASS) and ischemic monomelic neuropathy, as well as heart failure secondary to high output are additional contributors to morbidity and mortality. With the growing rate of end-stage renal disease (ESRD) in the United States and the contribution to morbidity and mortality by bleeding and other complications, it is essential to understand how to evaluate and treat these patients in the ED. This article reviews the evaluation and treatment of vascular access emergencies, as well as risk factors that contribute to complications in the ESRD patient population. The authors discuss evaluation and treatment of vascular access-related hemorrhage and nonhemorrhagic vascular access-related complications, along with the risk factors contributing to the increased bleeding in patients with end-stage renal disease.

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Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Cited by 3 publications

References 10 publications

Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study

Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study

A Prospective Observational Study on Multiplate®-, ROTEM®- and Thrombin Generation Examinations Before and Early After Implantation of a Left Ventricular Assist Device (LVAD)

Vascular Access Emergencies in the Dialysis Patient

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