Quantitative and Qualitative Platelet Derangements in Cardiac Surgery and Extracorporeal Life Support

Squiccimarro, Enrico; Jiritano, Federica; Serraino, Giuseppe Filiberto; Cate, Hugo Ten; Paparella, Domenico; Lorusso, Roberto

doi:10.3390/jcm10040615

Cited by 10 publications

(11 citation statements)

References 126 publications

(183 reference statements)

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“…Contemporary knowledge entrusts a crucial purpose to platelets beyond hemostasis: the thread of thrombosis and immuno‐inflammation 72 . The blood–surface interaction primes thrombocytes determining a dynamic equilibrium of adsorption‐release of degraded platelets 3 .…”

Section: Cellular Elementsmentioning

confidence: 99%

Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass

et al. 2022

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Background Data from large cardiac surgery registries have been depicting a downward trend of mortality and morbidities in the last 20 years. However, despite decades of medical evolution, cardiac surgery and cardiopulmonary bypass still provoke a systemic inflammatory response, which occasionally leads to worsened outcome. This article seeks to outline the mechanism of the phenomenon. Methods A thorough review of the literature has been performed. Criteria for considering studies for this non‐systematic review were as follows: observational and interventional studies investigating the systemic inflammatory response to cardiac surgery, experimental studies describing relevant molecular mechanisms, and essential review studies pertinent to the topic. Results The intrinsic variability of the inflammatory response to cardiac surgery, together with its heterogenous perception among clinicians, as well as the arduousness to early discriminate high‐responder patients from those who will not develop a clinically relevant reaction, concurred to hitherto unconclusive randomized controlled trials. Furthermore, peremptory knowledge about the pathophysiology of maladaptive inflammation following heart surgery is still lacking. Conclusions Systemic inflammation following cardiac surgery is a frequent entity that occasionally becomes clinically relevant. Specific genomic differences, age, and other preoperative factors influence the magnitude of the response, which elements display extreme redundancy and pleiotropism that the target of a single pathway cannot represent a silver bullet.

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Section: Cellular Elementsmentioning

confidence: 99%

Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass

et al. 2022

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“…During cardiac surgery, clot force development decreased with the duration of cardiopulmonary bypass, possibly induced by a reduction of the αIIbβ3 receptors on the platelet surface [53]. It is, however, important to emphasize, that there are multiple mechanisms leading to alterations of the coagulation system during cardiopulmonary bypass [54].…”

Section: Acquired Diseases With Altered Clot Retractionmentioning

confidence: 99%

Clot Retraction: Cellular Mechanisms and Inhibitors, Measuring Methods, and Clinical Implications

Jansen

Hartmann

2021

Biomedicines

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Platelets have important functions in hemostasis. Best investigated is the aggregation of platelets for primary hemostasis and their role as the surface for coagulation leading to fibrin- and clot-formation. Importantly, the function of platelets does not end with clot formation. Instead, platelets are responsible for clot retraction through the concerted action of the activated αIIbβ3 receptors on the surface of filopodia and the platelet’s contractile apparatus binding and pulling at the fibrin strands. Meanwhile, the signal transduction events leading to clot retraction have been investigated thoroughly, and several targets to inhibit clot retraction have been demonstrated. Clot retraction is a physiologically important mechanism allowing: (1) the close contact of platelets in primary hemostasis, easing platelet aggregation and intercellular communication, (2) the reduction of wound size, (3) the compaction of red blood cells to a polyhedrocyte infection-barrier, and (4) reperfusion in case of thrombosis. Several methods have been developed to measure clot retraction that have been based on either the measurement of clot volume or platelet forces. Concerning the importance of clot retraction in inborn diseases, the failure of clot retraction in Glanzmann thrombasthenia is characterized by a bleeding phenotype. Concerning acquired diseases, altered clot retraction has been demonstrated in patients with coronary heart disease, stroke, bronchial asthma, uremia, lupus erythematodes, and other diseases. However, more studies on the diagnostic and prognostic value of clot retraction with methods that have to be standardized are necessary.

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“…On ECMO, blood exposure to the artificial surface of the circuit, inflammatory response, and shear stress-induced platelet activation are the main reasons for a consumptive coagulopathy, which is believed to play an important role in the increased risk of thrombosis and bleeding ( 2 , 3 ). Qualitative and quantitative platelet dysfunction is well described in patients receiving ECMO support, which leads clinicians to transfuse platelet and other blood product transfusion to achieve hemostatic balance ( 3 ). Among the children receiving ECMO support, 97% received at least one platelet transfusion ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of Platelet Transfusions on Extracorporeal Life Support Oxygenator’s Function

Chegondi

Vijayakumar²,

Badheka

et al. 2022

Front. Pediatr.

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ObjectiveBleeding is a common complication of extracorporeal membrane oxygenation (ECMO), leading to increased mortality. Since one of its main complications is bleeding, platelet transfusions are frequently prescribed for children on ECMO. However, there is currently very little information on the effect of platelet transfusions on the function of the ECMO oxygenator. Our objective was to describe the effect of platelet transfusions on oxygenator function.MethodsIn this retrospective study, we included all children (<18 years) who received ECMO support in our pediatric intensive care unit (PICU) between January 2017 and December 2019. Oxygenator function, measured before and after platelet transfusion, was assessed by post-oxygenator PECMOO2 and the gradient in pre- post-oxygenator pressures (Delta Pressure).ResultsOver 3 years, we analyzed 235 platelet transfusions from 55 children who received ECMO support. Thirty-two (80%) of children were on veno-arterial ECMO and majority of them were peripherally cannulated. When looking at all transfusions, the post-transfusion change in delta-pressure was 0.1 mmHg (p = 0.69) and post-membrane PECMOO2 was 6 mmHg (p = 0.49). However, in the subgroup with the lowest quartile of pre-transfusion oxygenator function, the post-transfusion change in delta-pressure was −5.2 ± 2.7 mmHg (p < 0.001) and the post-transfusion change in PECMOO2 was −118 ± 49 (p < 0.001). The area under the ROC curve for the pre-transfusion delta-pressure and PECMOO2 to predict a worsening of the oxygenator function were 0.72 (95%CI 0.63–0.81) and 0.71 (95%CI 0.64–0.78), respectively. Using regression models, pre-transfusion delta-pressure and PECMOO2 were the only independent factors associated with oxygenator function worsening (p < 0.001).ConclusionOur study suggests that overall, platelet transfusions do not seem to impact the ECMO oxygenator’s function. However, in the subgroup of patients with the lowest pre-transfusion oxygenator function, platelet transfusions were independently associated with a worsening function. Future studies should investigate if this warrants adjustments of the anticoagulation strategy around the platelet transfusion, especially among patients with lower oxygenator function.

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Quantitative and Qualitative Platelet Derangements in Cardiac Surgery and Extracorporeal Life Support

Cited by 10 publications

References 126 publications

Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass

Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass

Clot Retraction: Cellular Mechanisms and Inhibitors, Measuring Methods, and Clinical Implications

Effect of Platelet Transfusions on Extracorporeal Life Support Oxygenator’s Function

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