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

Abstract

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.

Coagulation and Transfusion Updates From 2021

“…Additionally, Multiplate-ADP 50 units correlated with statistically significant increases in total transfusion (20%), RBC (15%), platelets (35%), and cryoprecipitate (10%). 99 These findings were similar to the results of previous studies. 100 Larger metanalysis have been conflicting on the ability of PFT to reduce transfusion and predict bleeding.…”

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

“…The article "The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational trial" by Matkovic et al 1 was read with great enthusiasm. It was fortunate to read this manuscript, and the author's efforts are worthy of praise.…”