Clot Impedence As An Indicator Of Platelet Dysfunction Following Cardiopulmonary Bypass

1981 ◽  
Author(s):  
A Saleem ◽  
D H Yawn ◽  
S A Saleh ◽  
E S Crawford
Keyword(s):  
Cardiopulmonary Bypass ◽  
Blood Sample ◽  
Platelet Function ◽  
Postoperative Bleeding ◽  
Coagulation Factors ◽  
Initial Slope ◽  
Platelet Dysfunction ◽  
Number Of Patients ◽  
Precision Evaluation ◽  
Surgical Bleeding

Post-operative bleeding following cardiopulmonary bypass remains a serious problem. Recent studies have indicated platelet dysfunction may be responsible for altered hemostasis in a significant number of patients. Although evaluation of coagulation factors can usually be done with speed and precision, evaluation of platelet function is time-consuming. We have evaluated a clot impedence device (Sonoclot®, Sieneo Inc., Colorado) to measure platelet function. The device measures and records the clot impedence to a vibrating probe as the blood sample clots and retracts. In our evaluation of healthy subjects, we found the initial slope of the impedence curve and the entire retraction phase are influenced by the number of platelets. Extrapolating this information to the patients undergoing cardiovascular bypass, we found 7 out of 11 patients with postoperative bleeding had poor retraction phase in spite of an adequate platelet count. This suggested platelet dysfunction. All seven patients achieved satisfactory hemostasis after platelet transfusion. This was correlated with a normal clot impedence study. Four patients with normal clot impedence were found to have surgical bleeding. The test is easy to perform and the result is available within fifteen minutes of drawing the blood sample. In our hands, the measurement of clot impedence appears to be a reliable adjunct in the etiological diagnosis of post-operative bleeding.

scholarly journals Effect of Cardiopulmonary Bypass Machine on the Platelet Function Testing.

2020 ◽  
Author(s):  
Khalid A. AlSaleh ◽  
Rashed B. AlBakr ◽  
Turki B. AlBacker ◽  
Rakan AlNazer ◽  
Abdulkareem Almomen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Platelet Function ◽  
Clinical Decision Making ◽  
Complete Blood Count ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Inverse Correlation ◽  
Platelet Dysfunction ◽  
Significant Difference

Abstract Background: Bleeding during coronary artery bypass surgery is a leading cause of mortality. Several factors have been associated with bleeding, platelet dysfunction being the most significant.Objective: to assess the effect of cardiopulmonary bypass machine (CPB) during cardiac surgery on platelet function using Platelet Function Analyzers (PFA-100), and Multiplate Electrode Aggregometry (MEA), and correlating that with a drop in Hemoglobin (Hb).Methods: Whole blood samples were collected preoperative and sixty minutes intraoperatively of different cardiac procedures utilizing (CPB) and tested for platelet function by PFA-100 and MEA. Complete blood count was measured using an automated hematology analyzer.Results: A significant difference was found between pre- and intraoperative ADP and EPI measurement in PFA-100, where preoperative PFA-ADP values displayed the ability to predict the intra-op drop in Hb (P–value 0.01, correlation coefficient 0.4699). At the same time, pre-op MEA- Ristocetin and TRAP showed an inverse correlation with an intra-op drop in Hb (-0.31 and -0.36). Conclusion: The current study reported significant changes in platelet dysfunction in cardiac surgeries with CPB, measured by two modalities PFA-100, and MEA. While PFA-100 and MEA both detected the changes in platelet dysfunction due to CPB, PFA-100 results were sensitive and positively predicted intra-op Hb drop as compared to MEA. There was a significant change in Hb one hour into the CPB, indicating that platelet transfusion might help decrease Intra- and postoperative bleeding independent of the platelet count as they are dysfunctional. PFA-100 results can be relied upon for distinction of high-risk cardiac surgery patients for bleeding and can be used for clinical decision making to improve patient outcome.

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 138-144
Author(s):  
Helena Argiriadou ◽  
Polychronis Antonitsis ◽  
Anna Gkiouliava ◽  
Evangelia Papapostolou ◽  
Apostolos Deliopoulos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Correlation Coefficient ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Minimal Invasive ◽  
Elective Cardiac Surgery ◽  
Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

scholarly journals Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

2020 ◽  
Vol 132 (1) ◽  
pp. 95-106 ◽  
Author(s):  
Audrey Dieu ◽  
Maria Rosal Martins ◽  
Stephane Eeckhoudt ◽  
Amine Matta ◽  
David Kahn ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Postoperative Bleeding ◽  
Fresh Frozen Plasma ◽  
Postoperative Blood Loss ◽  
Blood Product Transfusion ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Number Of Patients ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. Results Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg−1 (5.1, 9.4) in the FFP group and 5.7 ml · kg−1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. Conclusions The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

Agents that modify haemostasis after cardiopulmonary bypass

Perfusion ◽  
1993 ◽  
Vol 8 (1_suppl) ◽  
pp. 6-12
Author(s):  
Richard D Weisel
Keyword(s):  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Platelet Activation ◽  
Platelet Function ◽  
Heart Surgery ◽  
Postoperative Bleeding ◽  
Whole Body ◽  
Antifibrinolytic Agents ◽  
Review Reports

Reducing the whole body inflammatory response to cardiopulmonary bypass may reduce postoperative bleeding. Dipyridamole decreases platelet activation, deposition, and depletion. Antifibrinolytic agents may further reduce bleeding by reducing fibrinolysis and maintaining platelet function. This review reports the author's experience with dipyridamole and antifibrinolytic agents, membrane and bubble oxygenators, as well as the effects of warm and cold heart surgery.

Effect of Prolonged Hypothermic Cardiopulmonary Bypass, Heparin, and Protamine on Platelet: A Small-Group Study

2021 ◽  
Author(s):  
Danny Epstein ◽  
Andrey Vishnepolsky ◽  
Gil Bolotin ◽  
Nardeen Atweh ◽  
Lilach Bonstein ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Postoperative Bleeding ◽  
Annexin V ◽  
Adenosine Diphosphate ◽  
Thrombin Receptor ◽  
Platelet Dysfunction ◽  
Receptor Activator ◽  
Leukocyte Aggregation ◽  
Platelets Function ◽  
Apoptosis Marker

AbstractCardiopulmonary bypass (CPB) is associated with platelet dysfunction (PD), an important cause of postoperative bleeding. The etiology of PD is not completely understood. We mapped the platelets' function during CPB to determine the etiology of PD. Platelets activation, measured by procaspase activating compound-1 and P-selectin expression (CD62P), after activation by adenosine diphosphate and thrombin receptor activator peptide, were decreased by protamine. Changes during CPB were insignificant. Platelet-leukocyte aggregation was increased by CPB but not by protamine. Platelet apoptosis marker, annexin V, was increased by protamine. Changes during CPB were insignificant. Our findings demonstrate that protamine given after CPB plays a central role in PD and count decrease.

Nitroglycerin and Sodium Nitroprusside: Potential Contributors to Postoperative Bleeding?

2012 ◽  
Vol 15 (2) ◽  
pp. 92 ◽  
Author(s):  
Donald Clark ◽  
Stephanie Tesseneer ◽  
Curtis G. Tribble
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Sodium Nitroprusside ◽  
Platelet Activation ◽  
Postoperative Bleeding ◽  
Antihypertensive Agents ◽  
Platelet Inhibition ◽  
Clinical Consequence ◽  
Platelet Dysfunction ◽  
Knowing That

Postoperative bleeding is common in patients undergoing cardiac surgery with cardiopulmonary bypass. Most cases of severe postoperative bleeding not due to incomplete surgical hemostasis are related to acquired transient platelet dysfunction mediated by platelet activation during contact with the synthetic surfaces of the cardiopulmonary bypass equipment. Antihypertensive agents nitroglycerin and sodium nitroprusside have been shown to have platelet inhibitory properties, yet the clinical consequence in terms of postoperative bleeding has been little studied. Knowing that cardiopulmonary bypass causes platelet dysfunction, it is prudent for physicians to be aware of the additional platelet inhibition caused by these commonly used antihypertensive agents.

Platelet dysfunction after normothermic cardiopulmonary bypass in children: Effect of high-dose aprotinin

2007 ◽  
Vol 98 (08) ◽  
pp. 385-391 ◽  
Author(s):  
Claire Flaujac ◽  
Philippe Pouard ◽  
Pierre Boutouyrie ◽  
Joseph Emmerich ◽  
Christilla Bachelot-Loza ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Protective Effect ◽  
Platelet Activation ◽  
Platelet Function ◽  
Pediatric Patients ◽  
High Dose ◽  
Platelet Dysfunction ◽  
High Dose Aprotinin ◽  
Marker Expression ◽  
Heparin Neutralization

SummaryPlatelet dysfunction after cardiopulmonary bypass (CPB) can contribute to excessive post-operative bleeding. Most trials of the protective effect of aprotinin in this setting have involved hypothermic CPB, which is more deleterious for platelets than normothermic CPB.Here we investigated the effect of aprotinin on platelet function during normothermic CPB in pediatric patients. Twenty patients (9 newborns [<1 month old] and 11 infants [<36 month old]),weighting less than 15 kg and undergoing normothermic CPB (35–36°C) were randomly assigned to two equal groups,one of which received high-dose aprotinin.Platelet function was assessed by flow cytometry just before CPB and 5 minutes after heparin neutralization. F1+2 fragments were measured by ELISA before and 5 minutes after CPB. Platelet activation marker expression (CD62P and activated αIIbβ3) induced by ADP or TRAP was lower after CPB than before CPB, suggesting a deleterious effect of normothermic CPB on platelet function. Prothrombin fragment F1+2 levels increased after CPB. Aprotinin administration did not influence the level of prothrombin fragments or platelet marker expression measured in basal condition. However, after CPB, the capacity for platelet activation was higher in the aprotinin group, as shown by measuring CD62P expression afterTRAP activation (p=0.05).This study suggests that pediatric normothermic CPB causes platelet dysfunction, and that high-dose aprotinin has a protective effect.

scholarly journals Utility of Platelet Function Tests: A Recent Review Round Up

2019 ◽  
Vol 03 (01) ◽  
pp. 24-27
Author(s):  
Sandeep Sharan ◽  
Ajay Gandhi ◽  
Poonam Malhotra Kapoor
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Platelet Function ◽  
Postoperative Bleeding ◽  
Platelet Dysfunction ◽  
Platelet Function Tests ◽  
Excessive Bleeding ◽  
Function Tests ◽  
Increased Risk ◽  
Hemostatic Therapy

AbstractPatients undergoing cardiac surgery are at risk of excessive bleeding and associated complications. Excessive bleeding during and after cardiac surgery has an incidence of ~20%. Massive bleeding and subsequent requirement for blood product administration and mediastinal re-exploration is associated with significant morbidity and mortality. Postoperative, nonsurgical bleeding in cardiac surgical patients is often multifactorial. Platelet dysfunction, excessive fibrinolysis, hypothermia, preoperative anemia, and deficiency of coagulation factors or their dilution are all suggested etiologies of postoperative bleeding. Among these, the most important is thought to be platelet dysfunction, which occurs as a result of the interplay of acquired and pharmacologically induced factors. Patients suffering from coronary artery disease are usually advised to stop antiplatelet medication a few days prior to coronary artery bypass grafting (CABG) to reduce the incidence of postoperative bleeding. However, patients who are still on antiplatelet drugs are at an increased risk of postoperative bleeding. Currently, the transfusion of blood and blood components to manage postoperative bleeding after CABG remains largely empirical, with considerable variation among institutions. Algorithm-based hemostatic therapy has been shown to be superior to empiric hemostatic therapy that is based on clinical judgment. Hence, there is a need to have objective tests to demonstrate platelet dysfunction before platelet transfusion. Several devices of platelet function tests have been reported in clinical studies to evaluate platelet dysfunction and quantify the need for antiplatelet therapy

A Comparison of Defective Platelet Count and Aggregation between the Valve Replacement and Cyanotic Congenital Heart Cases during Cardiopulmonary Bypass

Perfusion ◽  
1987 ◽  
Vol 2 (2) ◽  
pp. 87-95
Author(s):  
Yan-Ji Gu ◽  
Yi-Shan Wang ◽  
Chun-Xiu Ye
Keyword(s):  
Platelet Count ◽  
Cardiopulmonary Bypass ◽  
Platelet Aggregation ◽  
Valve Replacement ◽  
Congenital Heart ◽  
Postoperative Bleeding ◽  
Significant Negative Correlation ◽  
Platelet Dysfunction ◽  
Group A ◽  
The Mean

Platelet count and ADP-induced platelet aggregation were studied in 10 single valve replacement (VR) patients and 10 cyanotic congenital heart disease (CCHD) patients undergoing cardiopulmonary bypass (CPB). The mean platelet count dropped to 78% in VR group and 73% in CCHD group at 30 minutes CPB as compared with the prebypass levels (being corrected for haemodilution). The mean prebypass platelet aggregation value was 65·5% ± 7·5% (Mean ± SEM) in VR group and 56·5% ± 5·2% in CCHD group; the values dropped to 54·2% ± 4·5% and 28·2% ± 4·8% respectively in VR and CCHD groups ( P < 0·01) at 30 minutes CPB. Both groups had a slight further drop at the end of the CPB, but only CCHD group had a further drop in platelet aggregation function after protamine administration. Mean plasma haemoglobin was much higher in the CCHD group than that in VR group at the termination of the bypass ( P < 0·05). Increased blood transfusion volumes were needed and greater blood losses noticed in the CCHD group. A significant negative correlation ( r = 0·5044. P < 0·05) was found between platelet function measured at the termination of CPB and postoperative bleeding. Cardiopulmonary bypass in patients with CCHD appears to be associated with greater platelet dysfunction and this results in more serious haemostatic defects after CPB. It is necessary to have further studies of the defective haemorrhagic status in these patients. More advanced perfusion techniques should be applied to preserve platelets during cardiopulmonary bypass.

The Current Role of Platelet Function Testing in Clinical Practice

2021 ◽  
Author(s):  
George A. Mason ◽  
David J. Rabbolini
Keyword(s):  
Clinical Practice ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Management Strategies ◽  
Postoperative Bleeding ◽  
Platelet Dysfunction ◽  
Vascular Events ◽  
Vascular Intervention ◽  
Platelet Function Testing ◽  
Function Testing

AbstractPlatelet dysfunction, whether hereditary or acquired, may increase an individual's risk of spontaneous, posttraumatic, or postoperative bleeding. Conversely, increased platelet reactivity on antiplatelet agents following vascular (in particular, coronary vascular) intervention may increase the risk of thrombosis and adverse vascular events. The aim of platelet function testing is to identify and characterize platelet dysfunction in these settings to inform bleeding/ thrombosis risk and guide perioperative prophylactic management strategies. A vast array of screening and diagnostic tests is available for this purpose. The successful clinical application of platelet function tests depends on the knowledge of their analytical strengths and limitations and the correct extrapolation of derived results to a particular clinical scenario. This review critically appraises traditional and contemporary platelet function testing focusing on their role in clinical practice.

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