title: Predicting Bleeding Risk by Platelet Function Testing in Patients Undergoing Heart Surgery.
abstract: BACKGROUND
  Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes.
  
  
  OBJECTIVE
  To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG.
  
  
  METHODS
  Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry.
  
  
  RESULTS
  In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk.
  
  
  CONCLUSIONS
  In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate.
authors.affiliation: Department of Cardiology, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Kuliczkowski
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sliwka
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kaczmarski
authors.affiliation: Department of Medical Emergency, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Zysko
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Zembala
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Damian
authors.initials: D
authors.lastname: Steter
authors.affiliation: Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.affiliation: HeartDrug Research Laboratories, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Seth
authors.initials: S
authors.lastname: Fortmann
authors.affiliation: HeartDrug Research Laboratories, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Victor
authors.initials: V
authors.lastname: Serebruany
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017707:Erythrocyte Transfusion; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin