Quantifying immature platelets as markers of increased platelet production after coronary artery bypass grafting surgery

Xu, Ke; Chan, Noel; Hirsh, Jack; Ginsberg, Jeffrey S.; Bhagirath, Vinai; Krüger, Paul-Christian; Dale, Brian; Crowther, Mark; Whitlock, Richard; Li, Chunjian; Eikelboom, John W.

doi:10.1111/ejh.13109

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…The trajectory of platelet count is shown in Fig. 3D and its pattern is similar to previous researches [16,22,23]. During CPB, the platelets were severely diluted and damaged and about 80% of patients required platelet transfusion to control bleeding from the suturing properly.…”

Section: Coagulation System Risk Factorssupporting

confidence: 79%

Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Wang

Dun

et al. 2021

J Cardiothorac Surg

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Background Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded. Results The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions The ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

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Section: Coagulation System Risk Factorssupporting

confidence: 79%

Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Wang

Dun

et al. 2021

J Cardiothorac Surg

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“…Several potential explanations have been proposed for the nature of high on-treatment platelet reactivity, including modifiable factors: too low doses of anti-platelet drugs, high platelet turnover, oxidative stress, dyslipidaemia and inflammation [7][8][9][10][11][12]. Coronary artery bypass grafting surgery itself is associated with excessive activation of platelets, which results in stimulation of the production and release of young platelets [2,13,14].…”

Section: Introductionmentioning

confidence: 99%

Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting

et al. 2019

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Introduction: Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period. Material and methods: In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers. Results: Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, p < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, p < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, p < 0.0001, TNF-α = 0.37, p < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), p < 0.04, and 9 (20.9%) vs. 4 (6.7%), p < 0.04, respectively. Conclusions: Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.

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“…Previous research also observed this phenomenon and argued that this process is indicative of a persistent platelet activation and aggregation in the first three postoperative days. [16,22,23] In the present study, the platelet count delayed to show the rising tendency in the conventional group because those patients experienced a larger quantity of blood loss from the chest tube in the first 3 preoperative days. There were 69.2% of patients in the ABO group and 82.6% in the conventional group (P = 0.003) whose last re-examination of platelet count during in hospital stay was higher than the preoperative level (platelet rebound).…”

Section: Coagulation System Risk Factorsmentioning

confidence: 46%

“…The trajectory of platelet count is shown in Figure 3D and its pattern is similar to previous researches. [16,22,23] During CPB, the platelets were severely diluted and damaged and about 80% of patients required platelet transfusion to control bleeding from the suturing properly. Even with the plasma and platelet transfusion, the bleeding from the chest tube was still relatively large in the earlier postoperative days [Table and Supplementary Figure 1].…”

Section: Coagulation System Risk Factorsmentioning

confidence: 99%

Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

Dun

Wang

2021

Preprint

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Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 minutes, which increases the surgical risk. We invented an aortic balloon occlusion technique that requires 5 minutes of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods: This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of aortic balloon occlusion group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during the in-hospital stay were also recorded. Results: The 30-day mortality rates were similar between the aortic balloon occlusion group (4.6%) and the conventional group (7.8%, P = 0.241). Multivariate analysis showed aortic balloon occlusion reduced postoperative acute kidney injury (23.1% vs 35.7%, P = 0.013) and hepatic injury (12.3% vs 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions: The aortic balloon occlusion achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

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Quantifying immature platelets as markers of increased platelet production after coronary artery bypass grafting surgery

Abstract: Of the 3 markers, IPC was the most promising as surrogates for platelet production. Future studies should evaluate the utility of the IPC to identify patients with cardiovascular disease with reduced response to aspirin who might benefit from twice-daily aspirin.

Cited by 7 publications

References 20 publications

Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting

Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

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