title: Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery.
abstract: Individual variability in the response to antiplatelet therapy (APT), frequently administered preoperatively, has been established by various platelet function assays and could reflect bleeding tendency after coronary artery bypass surgery (CABG). Our hypothesis is that multiple electrode whole-blood aggregometry (MEA) can identify patients at risk for excessive bleeding. We enrolled 211 patients (155 male and 56 female) undergoing isolated CABG in a prospective observational study. Patients were divided into four groups with respect to their preoperative APT management. MEA, using the ASPI and the ADP test, was performed prior to surgery. The primary endpoint was chest tube output (CTO) and the secondary endpoint was perioperative packed red blood cell concentrate (PRBC) administration. Patients were characterized as bleeders if their 24 h CTO exceeded the 75th percentile of distribution. 24 h CTO value of 11.33 ml/kg presented 75th percentile of distribution, thus cut-off value for "bleeder category". The proportion of patients characterized as bleeders was significantly different among the groups in regard to preoperative APT (p = 0.039). Significant differences in both ASPI (p < 0.001) and ADP (p = 0.038) tests were observed between different preoperative APT groups. Significant correlations between the ASPI test (r = -0.170, p = 0.014) and ADP test (r = -0.206, p = 0.003) with 24 h CTO were found. The receiver operating curve revealed an ASPI test value of <20 area under curve (AUC) units (AUC 0.603, p = 0.023) and an ADP test <73 AUC (AUC 0.611, p = 0.009) as a "bleeder" determinant. The proportion of patients transfused with PRBC did not significantly differ among the groups in regard to preoperative APT (p = 0.636). Comparison of the ASPI test values between patients with respect to PRBC administration revealed lower values in the ASPI test in a group of patients transfused with PRBC (mean, 27.88 vs. 40.32 AUC, p = 0.002). Our study showed that MEA is a useful method of predicting CABG patients with excessive postoperative bleeding.
authors.affiliation: Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia. petricevic.mate@gmail.com
authors.forename: Mate
authors.initials: M
authors.lastname: Petricevic
authors.forename: Bojan
authors.initials: B
authors.lastname: Biocina
authors.forename: Davor
authors.initials: D
authors.lastname: Milicic
authors.forename: Sanja
authors.initials: S
authors.lastname: Konosic
authors.forename: Visnja
authors.initials: V
authors.lastname: Ivancan
authors.forename: Milan
authors.initials: M
authors.lastname: Milosevic
authors.forename: Ivan
authors.initials: I
authors.lastname: Burcar
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Gasparovic
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010979:Platelet Function Tests / Q000379:methods; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*
chemical_list: D010975:Platelet Aggregation Inhibitors