title: Preoperative point-of-care platelet function testing in cardiac surgery.
abstract: OBJECTIVE
  To investigate if the use of preoperative platelet function testing (PFT) as part of a transfusion algorithm reduced blood product usage in coronary artery bypass surgery (CABG).
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  A cardiothoracic hospital.
  
  
  METHODS
  249 patients having CABG surgery.
  
  
  METHODS
  The patients were allocated randomly to PFT preoperatively with Multiple Electrode Aggregometry (MEA, Group A), TEG PlateletMapping (PM, Group B) or none (control, Group C). Post-bypass bleeding management was determined by a transfusion algorithm.
  
  
  RESULTS
  The primary outcome measure was blood product transfusion in the first 48 hours post-surgery. There was a significant reduction in all blood product transfusion between Groups A (MEA) and B (PM) and Group C (control) (median number of units transfused, 2 (A)/2 (B)/ 4(C), p=0.02). Those in A and B received fewer units of red cells (median number of units, 0 (A)/1 (B) /2 (C), p=0.006) and fresh frozen plasma than the control Group C (median number of units, 0 (A)/0 (B)/2 (C), p<0.001), without receiving significantly more units of platelets (median number of units, 1 (A)/1 (B)/0 (C), p=0.11). In those who had taken an adenosine disphosphate (ADP)-receptor antagonist within 5 days (n=173), these results were amplified, and additionally, there was a significant cost saving (median cost, A=£1738.53, B=£1736.96, C=£3191.80 p=0.006).
  
  
  CONCLUSIONS
  Preoperative PFT as part of a point-of-care testing-based transfusion algorithm led to a reduction in blood transfusion. There is a potential cost saving in those who have taken an ADP-receptor antagonist within 5 days.
authors.affiliation: Departments of Anaesthesia and Critical Care. Electronic address: Seema.Agarwal@lhch.nhs.uk.
authors.forename: Seema
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Perfusion, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Robert Ian
authors.initials: RI
authors.lastname: Johnson
authors.affiliation: Departments of Anaesthesia and Critical Care.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology*; D001803:Blood Transfusion / Q000191:economics / Q000639:trends; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D010979:Platelet Function Tests / Q000191:economics / Q000379:methods; D019095:Point-of-Care Systems / Q000191:economics; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011446:Prospective Studies
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ADP-receptor antagonist; CABG; antiplatelet therapy; multiple electrode aggregometry; platelet mapping; point-of-care technology; transfusion