title: Early platelet recovery following cardiac surgery with cardiopulmonary bypass.
abstract: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is frequently associated with low platelet count (PC) and disturbed platelet function (PF). While PC is easy to measure, PF is more difficult to assess. Moreover, the time-related platelet dysfunction and recovery after CPB is not fully elucidated. Platelet dysfunction could lead to bleeding but also to coronary graft failure. Laboratory tests could provide more insights into PF after CABG. The aim of the current study was to investigate the time-related PF induced by CPB. Blood samples of 20 patients with a preoperative PC of more than 250 × 109/L were collected before incision, after weaning from CPB, and 24 h postoperative. Platelet contribution to coagulation was quantified by PLTEM (calculated by means of EXTEM and FIBTEM results). PF was assessed by multiple electrode impedance aggregometry (MEIA) in whole blood and by light transmission aggregometry (LTA) in platelet-rich plasma after stimulation with arachidonic acid (AA), adenosine diphosphate, collagen, and thrombin-receptor-activating peptide. LTA and MEIA analysis demonstrated significant platelet dysfunction after CPB, with partial recovery within 24 h after surgery. AA-induced platelet aggregation increased to higher levels within 24 h after surgery compared to baseline values as measured by LTA. PLTEM maximum clot firmness remained unchanged throughout the study. Correlation analyses revealed that MEIA and rotational thromboelastometry (ROTEM), but not LTA, were dependent on PC and hematocrit. No correlations were found between LTA, MEIA, ROTEM, PC, and clinical outcome parameters. Our results demonstrate a reversible platelet dysfunction recovering within 24 h after CPB. Interestingly, AA-induced platelet aggregation increases to higher levels during the first 24 h postoperatively, which might be important for early initiation of antiplatelet therapy after CABG. MEIA as POC test is able to detect platelet dysfunction during cardiac surgery with a PC of ≥150 × 109/L.
authors.affiliation: a Department of Anaesthesiology , Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg (ZOL) , Genk , Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Van Poucke
authors.affiliation: b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Stevens
authors.affiliation: c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: Wetzels
authors.affiliation: b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Cécile
authors.initials: C
authors.lastname: Kicken
authors.affiliation: c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Verhezen
authors.affiliation: b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Maurice
authors.initials: M
authors.lastname: Theunissen
authors.affiliation: b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Gerhardus
authors.initials: G
authors.lastname: Kuiper
authors.affiliation: c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Rene
authors.initials: R
authors.lastname: van Oerle
authors.affiliation: c Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Henskens
authors.affiliation: b Department of Anaesthesiology & Pain Treatment , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.|d Department of Intensive Care , Maastricht University Medical Centre (MUMC+) , Maastricht , The Netherlands.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lancé
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000097:blood* / Q000601:surgery; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D010976:Platelet Count; D010979:Platelet Function Tests; D011184:Postoperative Period; D013916:Thrombelastography; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis; D016896:Treatment Outcome
keywords: Cardiopulmonary bypass; light transmission aggregometry; multiple electrode impedance aggregometry; platelet activation; platelet aggregation; rotational thromboelastometry