title: Multiple electrode whole blood aggregometry, PFA-100, and in vivo bleeding time for the point-of-care assessment of aspirin-induced platelet dysfunction in the preoperative setting.
abstract: BACKGROUND
  Acquired platelet dysfunction due to aspirin ingestion may increase bleeding tendency during surgery. Thus, we examined the diagnostic accuracy of in vivo bleeding time (BT) and 2 platelet function assays for the preoperative assessment of a residual antiplatelet effect in patients treated with aspirin.
  
  
  METHODS
  Consecutive patients scheduled for surgery were prospectively enrolled in this study. The patients' last aspirin ingestion had occurred within the previous 48 hours before blood sampling in the "full aspirin effect" group, between 48 and 96 hours before in the "variable aspirin effect" group, and >96 hours before in the "recovered aspirin effect" group. The control group had not taken any aspirin. Multiple electrode aggregometry, platelet function analyzer (PFA)-100, and in vivo BT were performed to assess the effects of aspirin. One-way analysis of variance on ranks with a post hoc multiple-comparison procedure (Dunn) was used to detect differences among the groups. Categorical data were compared using the z test. Receiver operating characteristic (ROC) curves were created to determine the diagnostic accuracy of the platelet function assays investigated. The area under the ROC curve (AUC), sensitivity, and specificity of the assays were calculated. The level of statistical significance was set at P < 0.05.
  
  
  RESULTS
  Three hundred ninety-four patients were included in the analysis (133 control and 261 aspirin-treated patients). All 3 methods were able to detect the antiplatelet effect of aspirin in the full aspirin effect group. Furthermore, no difference in the measurement values between the recovered aspirin effect and control group was found, irrespective of the assay performed. Measurement values in the variable aspirin effect group were different from those of the control group in the ASPItest using multiple electrode aggregometry and COL-EPI using PFA-100 but not in BT. ROC analysis showed the highest diagnostic accuracy in excluding the residual aspirin effect in the ASPItest (AUC 0.81, P < 0.001), followed by COL-EPI (AUC 0.78, P < 0.001) and BT (AUC 0.56, P = 0.05). The cutoff value of 53 U in the ASPItest excluded the effect of aspirin with a sensitivity of 88% and specificity of 71%.
  
  
  CONCLUSIONS
  The full therapeutic antiplatelet effects of aspirin can be expected within 48 hours of the patient's last aspirin ingestion. Platelet function recovered in our study if aspirin cessation occurred >96 hours (4 days) before; thus, in these patients, preoperative platelet function testing is not useful. To quantify any residual aspirin effect in patients who ceased their intake of aspirin between 48 and 96 hours before surgery, the ASPItest might have the highest diagnostic accuracy.
authors.affiliation: Clinic for Anesthesiology, Working Group Perioperative Haemostasis, University of Munich, Max-Lebsche-Platz 32, D-81377 Munich, Germany. csilla.jambor@web.d
authors.forename: Csilla
authors.initials: C
authors.lastname: Jámbor
authors.forename: Klaus-Werner
authors.initials: KW
authors.lastname: von Pape
authors.forename: Michael
authors.initials: M
authors.lastname: Spannagl
authors.forename: Wulf
authors.initials: W
authors.lastname: Dietrich
authors.forename: Andreas
authors.initials: A
authors.lastname: Giebl
authors.forename: Heike
authors.initials: H
authors.lastname: Weisser
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D001760:Bleeding Time / Q000295:instrumentation / Q000379:methods*; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D010976:Platelet Count / Q000295:instrumentation / Q000379:methods; D019095:Point-of-Care Systems; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D014914:Whole Blood Coagulation Time / Q000295:instrumentation / Q000379:methods*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin