Point-of-care platelet function testing to predict blood loss after coronary artery bypass grafting surgery: a prospective observational pilot study

Ellis, James H.; Valencia, Oswaldo; Crerar-Gilbert, A.; Phillips, Simon; Meeran, Hanif; Sharma, Vivek

doi:10.1177/0267659116656774

Cited by 16 publications

(9 citation statements)

References 36 publications

(47 reference statements)

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“…The effects of CPB on platelet function were studied by Ellis and associates in 2016 [22]; the authors measured platelet function with TEG, TEG-PM, and MEA before and after CPB. All the tests showed a decreased platelet function after CPB; however, TEG and TEG-PM values did not predict bleeding after cardiac surgery.…”

Section: Modified Vet: Teg Platelet Mappingmentioning

confidence: 99%

Sensitivity of Viscoelastic Tests to Platelet Function

Ranucci

Baryshnikova

2020

JCM

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Viscoelastic tests provide a dynamic assessment of coagulation, by exploring the time to clot formation and the clot strength. Using specific activators or inhibitors, additional factors can be explored, like the fibrinogen contribution to clot strength. Since the early days, various attempts have been done to measure platelet function with viscoelastic test. In general, the difference between the maximum clot strength and the fibrinogen contribution is considered an index of platelet contribution. However, this parameter does not clearly split platelet count from function; additionally, the extensive thrombin generation of standard activated viscoelastic tests activates platelet through the protease activated receptors, bypassing the other pathways. For this reason, standard viscoelastic tests cannot be used to assess platelet reactivity under the effects of aspirin or P2Y12 inhibitors. To overcome this limitation, a specific test was developed (thromboelastography platelet mapping). This test has been compared with the gold standard of light transmission aggregometry and with other point-of-care tests, with conflicting results. In general, the use of viscoelastic tests to assess the effects of antiplatelet agents is still limited. Conversely, platelet contribution to clot strength in the setting of coagulopathic bleeding is considered an important parameter to trigger platelet transfusion or desmopressin.

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Section: Modified Vet: Teg Platelet Mappingmentioning

confidence: 99%

Sensitivity of Viscoelastic Tests to Platelet Function

Ranucci

Baryshnikova

2020

JCM

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“…In contemporary literature, the frequency of significant postoperative bleeding ranges from 5% to 50% 2 . The origin of the hemostatic disturbances after cardiac surgery is multifactorial—the effect of the heart‐lung machine (CPB) on platelet function, activated coagulation cascade, heparin‐induced coagulopathy, and fibrinolysis 3 . Postoperative morbidity caused by excessive bleeding is also a consequence of higher blood transfusion rate, as well as mechanisms that are not transfusion‐related 4 …”

Section: Introductionmentioning

confidence: 99%

The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational trial

et al. 2021

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Background: Preoperative use of platelet function tests contributes to the decrease of re-intervention rate due to bleeding and the necessity of transfusion in coronary artery bypass grafting (CABG) patients. The aim was to investigate the predictive value and to justify routine preoperative use of multiple electrode aggregometry in these patients. Methods: A prospective observational trial which included 416 consecutive patients subjected to elective isolated CABG was conducted. The Multiplate® test was used to assess platelet function. Platelet function test results, postoperative blood loss, and transfusion requirements were compared between high and low bleeding risk patients. Receiver operating characteristic analysis was performed to assess the sensitivity and specificity of the arachidonic acid (ASPI) and adenosine di-phosphate high sensitive (ADPHS) tests. Results: ADPHS and ASPI test results significantly predicted total bleeding > 1000 ml (AUC, 0.685, p < .001; 0.695, p = .039). Sensitivity and specificity were 62.9% and 40.0%, for ADPHS ≤602, and 70.8% and 41.8%, for ASPI ≤ 453. The sensitivity and specificity of cutoff values recommended by the manufacturer were 84.2% and 40.0% for ADPHS ≤ 500, while for ASPI < 600 the values were 54.7% and 62.2%. More platelets and cryoprecipitate were transfused in patients with ADPHS ≤ 602.5 (p < .001; p = .035). Patients with ADPHS ≤ 500 had a higher rate of red blood count, platelet and cryoprecipitate transfusion (p<.001p<.001; p = .013). The manufacturer's ASPI test cutoff values showed no statistically significant prediction for a higher transfusion rate. Conclusion: Preoperative platelet function tests should be conducted systematically for all elective CABG patients who were on dual antiplatelet therapy after adjusting test cutoff values for each population.

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“…A pilot study performed at our institute showed a superior predictive ability of the Multiplate to guide platelet transfusion as compared with Platelet Mapping. 17 Following this, Multiplate testing has become the standard of monitoring preoperative drug-induced platelet dysfunction at our institute. The Multiplate platelet function analyzer incorporates the use of impedance aggregometry to detect platelet function.…”

Section: Methodsmentioning

confidence: 99%

Implementation of Perioperative Point-of-Care Platelet Function Analyses Reduces Transfusion Requirements in Cardiac Surgery: A Retrospective Cohort Study

Wang

Valencia

Phillips

et al. 2020

Thorac Cardiovasc Surg

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Background Platelet dysfunction is a common cause of bleeding, perioperative blood transfusion, and surgical re-exploration in cardiac surgical patients. We evaluated the effect of incorporating a platelet function analyzer utilizing impedance aggregometry (Multiplate, Roche, Munich, Germany) into our local transfusion algorithm on the rate of platelet transfusion and postoperative blood loss in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Data were collected on patients undergoing CABG surgery from January 2015 to April 2017. Patients who underwent surgery before and after introduction of this algorithm were classified into prealgorithm and postalgorithm groups, respectively. The primary outcome was the rate of platelet transfusion before and after implementation of the Multiplate-based transfusion algorithm. Secondary outcomes included transfusion rate of packed red blood cells, postoperative blood loss at 12 and 24 hours, length of stay in the intensive care unit, and the hospital and mortality. Results A total of 726 patients were included in this analysis with 360 and 366 patients in the pre- and postalgorithm groups, respectively. Transfusion rates of platelets (p = 0.01) and packed red blood cells (p = 0.0004) were significantly lower following introduction of the algorithm in patients (n = 257) who had insufficient time to withhold antiplatelet agents. Receiver operating characteristic curves defined optimal cutoff points of arachidonic acid and adenosine diphosphate assays on the Multiplate to predict future platelet transfusion were 23AU and 43AU, respectively. Conclusions The introduction of a Multiplate-based platelet transfusion algorithm showed a statistically significant reduction in the administration of platelets to patients undergoing urgent CABG surgery.

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Point-of-care platelet function testing to predict blood loss after coronary artery bypass grafting surgery: a prospective observational pilot study

Abstract: This pilot study shows that preoperative multiplate testing may be a better predictor of platelet dysfunction and the resultant blood loss following cardiac surgery.

Cited by 16 publications

References 36 publications

Sensitivity of Viscoelastic Tests to Platelet Function

Sensitivity of Viscoelastic Tests to Platelet Function

The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational trial

Implementation of Perioperative Point-of-Care Platelet Function Analyses Reduces Transfusion Requirements in Cardiac Surgery: A Retrospective Cohort Study

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