Platelet Dysfunction Associated with Cardiopulmonary Bypass

Friedenberg, William R.; Myers, Wayne L.; Plotka, E. D.; Beathard, James N.; Kummer, D; Gatlin, Patience F.; Stoiber, Donald L.; Ray, Jefferson F.; Sautter, Richard D.

doi:10.1016/s0003-4975(10)63545-x

Cited by 87 publications

(14 citation statements)

References 23 publications

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“…There are many indicators of platelet abnormalities, including survival time, morphology, adhesiveness, size and volume, aggregation rate and sensitivity, and release of various substances [17,18]. Platelet aggregation was used in the present study because platelet dysfunction can be well expressed as a diminished sensibility to triggering agonists such as ADP, collagen, and epinephrine [19,20].…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

et al. 1997

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

et al. 1997

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“…Similarly, human platelets become less dense during cardiopulmonary bypass, apparently by release of serotonin and other granular contents; 29 they seem to maintain their integrity, but lose functionality. 8 …”

Section: Role Of Serotonin and Nitric Oxide In Pump-induced Hypotensionmentioning

confidence: 99%

“…However, patients on hemodialysis also seem at risk; although in our experiments on rats, hypotension remained absent when the blood was returned intravenously, as in hemodialysis, the clearance of serotonin by the lungs might be impaired in uremic patients because their basic level of serotonin is known to be elevated. 30 It has indeed been reported that in cardiopulmonary bypass and hemodialysis, platelets are activated, 7,8 and the levels of both serotonin 3,7 and NO synthesis are increased. 9,10,31 The prevention of pump-induced hypotension by 5-HT 2B -receptor blockade in this study suggests that 5-HT 2 -receptor antagonists may be candidates for clinical use.…”

Section: Clinical Interestmentioning

confidence: 99%

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Hypotension Caused by Extracorporeal Circulation

2002

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Background-Cardiopulmonary bypass and hemodialysis often cause hypotension. We investigated a possible role of pump-induced platelet activation with consequent serotonin release. Methods and Results-In rats, a heparin-coated extracorporeal shunt was placed between the proximal part of a carotid artery and the distal part of a femoral artery. Autoperfusion did not affect platelets or hemodynamics. Pump perfusion, however, immediately elicited strong platelet aggregation, whereas aortic pressure rapidly fell to 60Ϯ12% (meanϮSD) of its prepump value, partially recovered, and then progressively decreased to 70Ϯ12% at 2 hours. Femoral resistance doubled and then decreased to 59Ϯ11%. The initial changes in aortic pressure and femoral resistance were proportional to the amount of platelet aggregation, were accompanied by a rise (6-fold) in plasma serotonin levels downstream of the pump, but not in the aorta, and could be mimicked by serotonin-infusion into the leg. All hemodynamic changes were prevented or largely reduced by blockade of 5-hydroxytryptamine (5-HT) 2 receptors with pizotifen or ritanserin. The hypotension and femoral resistance decrease could also be prevented or abolished by inhibiting the production of nitric oxide (NO), an intermediate in 5-HT 2B receptor-induced vasodilation. When the extracorporeal blood was pumped into the aortic arch instead of the femoral artery, the hypotensive effect was similar and also NO dependent, but it was absent with venous return. Conclusions-Pump perfusion with arterial return of the blood causes hypotension by endothelial NO-release, which in turn is triggered by serotonin from activated platelets.

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“…Indeed, at one point, 14% of institutions were routinely giving platelets to all their post CPB patients, and another 28% were reserving platelets for such patients. [9][10][11][12][13][14] The economic and logistic demands that such a practice puts on an institution are staggering, not to mention the increased risk it presents to the patient from exposure to blood borne diseases. [15][16][17] There have also been multiple reports condemning the use of routine platelet transfusions in CPB patients.…”

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confidence: 99%

Effects of Platelet Transfusion on Post Cardiopulmonary Bypass Bleeding.

et al. 2001

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SUMMARYA common complication of cardiopulmonary bypass (CPB) surgery is post-operative bleeding that may result in re-exploration. Bleeding is often due to the coagulopathy that follows the procedure, rather than the surgical technique. Etiology of this coagulopathy has been attributed to platelet dysfunction. We reviewed the medical records of 592 patients who had undergone CPB surgery between 1992 and 1994. Bleeding times (both pre and post operative) in treated (those who received platelets) and untreated patients were recorded where available. Both groups showed a rise in bleeding time (295 sec versus 192 sec, respectively, p<0.001). However, the treated group had a greater increase in the bleeding time compared to the un-treated (p<0.05). The result was the same when we compared 2 subgroups with similar pre-operative bleeding times. When the treated group was subdivided into those who received >10 units of platelets and those who received <10 units, there was no significant difference in the increase in their bleeding times (p>0.1). Administration of platelets did not improve bleeding time abnormalities induced by CPB. Both treated and untreated groups had a significant rise in their bleeding times, irrespective of the amount of platelets administered. The mean rise in the bleeding time in patients who bled significantly to require surgical re-exploration (but did not receive platelets) was not significantly different from those who received platelets. These observations suggest that the administration of platelets has no clinical benefit in improving bleeding time following CPB. (Jpn Heart J 2001; 42: 425-433)

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Platelet Dysfunction Associated with Cardiopulmonary Bypass

Cited by 87 publications

References 23 publications

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

Hypotension Caused by Extracorporeal Circulation

Effects of Platelet Transfusion on Post Cardiopulmonary Bypass Bleeding.

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