title: The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting.
abstract: OBJECTIVE
  OBJECTIVE platelet function assessment after cardiac surgery can predict postoperative blood loss, guide transfusion requirements and discriminate the need for surgical re-exploration. We conducted this study to assess the predictive value of point-of-care testing platelet function using the Multiplate® device.
  
  
  METHODS
  Patients undergoing isolated coronary artery bypass grafting were prospectively recruited ( n = 84). Group A ( n = 42) patients were on anti-platelet therapy until surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at least 5 days preoperatively. Multiplate® and thromboelastography (TEG) tests were performed in the perioperative period. Primary end-point was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative. Secondary end-points included transfusion requirements, re-exploration rates, intensive care unit and in-hospital stays.
  
  
  RESULTS
  Patients in Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher re-exploration rates (14% vs. 0%, P < 0.01) and higher rate of blood (41% vs. 14%, P < 0.01) and platelet (14% vs. 2%, P = 0.05) transfusions. On multivariate analysis, preoperative platelet function testing was the most significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P = 0.08), need for blood (OR: 5.5, P < 0.01) and platelet transfusion (OR: 15.1, P < 0.01). Postoperative "ASPI test" best predicted the need for transfusion (sensitivity - 0.86) and excessive blood loss (sensitivity - 0.81). TEG results did not correlate well with any of these outcome measures.
  
  
  CONCLUSIONS
  Peri-operative platelet functional assessment with Multiplate® was the strongest predictor for bleeding and transfusion requirements in patients on anti-platelet therapy until the time of surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP, .
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.forename: Joyce
authors.initials: J
authors.lastname: Thekkudan
authors.forename: Raj
authors.initials: R
authors.lastname: Sahajanandan
authors.forename: Mike
authors.initials: M
authors.lastname: Gravenor
authors.forename: Suresh
authors.initials: S
authors.lastname: Lakshmanan
authors.forename: Khazi Mohammed
authors.initials: KM
authors.lastname: Fayaz
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
mesh_terms: D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010979:Platelet Function Tests / Q000379:methods*; D019095:Point-of-Care Systems; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D013916:Thrombelastography