title: Bleeding risk assessment in patients undergoing elective cardiac surgery using ROTEM(®) platelet and Multiplate(®) impedance aggregometry.
abstract: Impaired platelet function is a major risk factor for peri-operative bleeding and transfusion. This prospective, observational study enrolled 101 consecutive patients undergoing elective cardiac surgery with cardiopulmonary bypass. Platelet function was assessed by two whole blood impedance aggregometers (ROTEM(®) platelet and Multiplate(®) ), using three different activators (arachidonic acid, adenosine diphosphate and thrombin receptor-activating peptide-6), at three peri-operative time points (before anaesthesia, after aortic declamping and 5-10 min after protamine administration). Platelet function was impaired over the time-course in all assays. Results after protamine administration demonstrated the best correlation with postoperative chest tube drainage. Patients with a chest tube drainage exceeding the 75th percentile of the entire study population, during the first 24 postoperative hours, were characterised to have excessive bleeding. Both devices provided similar predictability for postoperative chest tube drainage and red blood cell transfusion requirements. The latter was associated with the degree of platelet inhibition and the number of pathways inhibited determined respective cut-off values.
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: M
authors.initials: M
authors.lastname: Petricevic
authors.affiliation: Department of Anesthesiology, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: S
authors.initials: S
authors.lastname: Konosic
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: B
authors.initials: B
authors.lastname: Biocina
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Dirkmann
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: A
authors.initials: A
authors.lastname: White
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Mihaljevic
authors.affiliation: Department of Anesthesiology, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: V
authors.initials: V
authors.lastname: Ivancan
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Konosic
authors.affiliation: University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Svetina
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.|TEM International GmbH, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Görlinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015505:Chest Tubes; D004322:Drainage; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D019106:Postoperative Hemorrhage / Q000209:etiology*; D018570:Risk Assessment
keywords: bleeding management; cardiac surgery; cardiopulmonary bypass; impedance aggregometry; multiple electrode aggregometry