Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry.
BACKGROUND
Platelet dysfunction contributes to the pathophysiology of bleeding complications during and after cardiac surgery. In most surgical institutions, no peri-operative point-of-care monitoring of platelet function is used. We evaluated the usefulness of the Multiplate platelet function analyser based on impedance aggregometry for identifying groups of patients at a high risk of transfusion of platelet concentrates (PC).


METHODS
Platelet function parameters were determined in 60 patients before and after routine cardiac surgery. Impedance aggregometry measurements were performed on Multiplate using ADP (ADPtest), collagen (COLtest) and thrombin receptor activating peptide (TRAPtest) as platelet activators. The correlations between the aggregometry results and the transfusion of PC were calculated. The results of the aggregation tests were also divided into tertiles and the differences in PC transfusion between the low and the high tertile were assessed.


RESULTS
Low aggregometry delimited groups of patients with significantly higher PC transfusion. In the receiver operating characteristic curve, low pre-operative aggregation in the ADPtest identified patients with high total transfusion of PC (area under the curve 0.74, P=0.001), while the ADPtest performed at the end of the operation identified patients with high PC transfusion on the intensive care unit (ICU) (area under the curve 0.76, P=0.002).


CONCLUSIONS
Near-patient platelet aggregation may allow the identification of patients with enhanced risk of PC transfusion, both pre-operatively and upon arrival on the ICU.
Rahe-Meyer
N
N
Department of Anaesthesiology, Hannover Medical School, Hannover, Germany. rahe-meyer.niels@mh-hannover.de
Winterhalter
M
M
Boden
A
A
Froemke
C
C
Piepenbrock
S
S
Calatzis
A
A
Solomon
C
C
D000244:Adenosine Diphosphate / Q000494:pharmacology; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003094:Collagen / Q000494:pharmacology; D017097:Electric Impedance; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation; D010979:Platelet Function Tests / Q000295:instrumentation* / Q000379:methods; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control*; D018179:Receptors, Thrombin; D012306:Risk; D016037:Single-Blind Method
D018179:Receptors, Thrombin; D000244:Adenosine Diphosphate; D003094:Collagen