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

Analysis of platelet function and dysfunction

2015 ◽  
Vol 35 (01) ◽  
pp. 60-72 ◽  
Author(s):  
K. Jurk
Keyword(s):  
Platelet Function ◽  
Posttranslational Modifications ◽  
Current Knowledge ◽  
Point Of Care ◽  
Screening Tests ◽  
Platelet Dysfunction ◽  
Platelet Function Tests ◽  
Function Tests ◽  
Diagnostic Potential ◽  
Platelet Function Disorders

SummaryAlthough platelets act as central players of haemostasis only their cross-talk with other blood cells, plasma factors and the vascular compartment enables the formation of a stable thrombus. Multiple activation processes and complex signalling networks are responsible for appropriate platelet function. Thus, a variety of platelet function tests are available for platelet research and diagnosis of platelet dysfunction. However, universal platelet function tests that are sensitive to all platelet function defects do not exist and therefore diagnostic algorithms for suspected platelet function disorders are still recommended in clinical practice.Based on the current knowledge of human platelet activation this review evaluates point-of-care related screening tests in comparison with specific platelet function assays and focuses on their diagnostic utility in relation to severity of platelet dysfunction. Further, systems biology-based platelet function methods that integrate global and specific analysis of platelet vessel wall interaction (advanced flow chamber devices) and posttranslational modifications (platelet proteomics) are presented and their diagnostic potential is addressed.

A Study of Platelet Functions with a New Analyzer Using High Shear Stress (PFA100™) in Patients Undergoing Coronary Artery Bypass Graft

2000 ◽  
Vol 84 (11) ◽  
pp. 794-799 ◽  
Author(s):  
Annick Fiemeyer ◽  
Gilles Chatellier ◽  
Carine Chammas ◽  
Jean-François Baron ◽  
Martine Aiach ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Platelet Dysfunction ◽  
Excessive Bleeding ◽  
Increased Risk

SummaryPlatelet dysfunction can be a major factor in excessive bleeding following cardiopulmonary bypass (CBP). A rapid, specific and sensitive method to identify platelet dysfunction would be a useful tool for identifying patients at an increased risk of bleeding. The ability of PFA100™, an in vitro bleeding test, to predict increased bleeding risk linked to platelet dysfunction was tested in 146 patients undergoing primary coronary artery bypass graft. Blood samples were taken the day before surgery, and 15 min and 5 h after heparin neutralization. The preoperative closure times (CT), i. e. the time required for platelets in citrated whole blood to occlude an aperture cut into a membrane coated with collagen plus either epinephrine (CTEPI) or adenosine diphosphate (CTADP) were longer in blood-group-O patients than in patients with other groups. The 15 min postoperative values were significantly longer from preoperative values essentially owing to CBP-induced hemodilution. Interestingly, 5 h after CBP, a significant reduction in CT values probably reflected platelet hyperaggregability. No correlation was found between calculated blood loss (CBL) and either preoperative or postoperative PFA values.

Tranexamic Acid Administration after Cardiac Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Valter Casati ◽  
Ferdinando Bellotti ◽  
Chiara Gerli ◽  
Annalisa Franco ◽  
Michele Oppizzi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Postoperative Period ◽  
Postoperative Bleeding ◽  
Postoperative Treatment ◽  
Outcome Variable ◽  
Double Blind ◽  
Excessive Bleeding ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Background Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg x kg(-1) x h(-1) for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg x kg(-1) x h(-1) for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg x kg(-1) x h(-1) tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

scholarly journals Platelet Function Tests: A Review of Progresses in Clinical Application

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Jae-Lim Choi ◽  
Shuhua Li ◽  
Jin-Yeong Han
Keyword(s):  
Clinical Application ◽  
Platelet Function ◽  
Immunomodulatory Activity ◽  
Platelet Function Tests ◽  
Function Tests ◽  
Mediators Of Inflammation ◽  
Increased Risk ◽  
Integral Role ◽  
Thrombotic Diseases

The major goal of traditional platelet function tests has been to screen and diagnose patients who present with bleeding problems. However, as the central role of platelets implicated in the etiology of arterial thrombotic diseases such as myocardial infarction and stroke became widely known, platelet function tests are now being promoted to monitor the efficacy of antiplatelet drugs and also to potentially identify patients at increased risk of thrombosis. Beyond hemostasis and thrombosis, an increasing number of studies indicate that platelets play an integral role in intercellular communication, are mediators of inflammation, and have immunomodulatory activity. As new potential biomarkers and technologies arrive at the horizon, platelet functions testing appears to take on a new aspect. This review article discusses currently available clinical application of platelet function tests, placing emphasis on essential characteristics.

scholarly journals Comparison of three common whole blood platelet function tests for in vitro P2Y12 induced platelet inhibition

2019 ◽  
Vol 50 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Joao D. Dias ◽  
Torben Pottgiesser ◽  
Jan Hartmann ◽  
Daniel Duerschmied ◽  
Christoph Bode ◽  
...  
Keyword(s):  
Platelet Function ◽  
Whole Blood ◽  
Linear Models ◽  
Point Of Care ◽  
Platelet Function Tests ◽  
Blood Samples ◽  
P2y12 Inhibitors ◽  
Function Tests ◽  
Increased Risk

Abstract In the context of interventional cardiology, platelet function testing may identify patients treated with P2Y12-inhibitors at an increased risk of mortality, thrombosis and bleeding. Several whole blood point-of-care platelet function analyzers are available; however, inter-device differences have not been examined systematically. To compare three platelet function tests under standardized in vitro conditions. Healthy volunteer (n = 10) blood samples were spiked with increasing concentrations of ticagrelor (0–7500 ng/mL) and/or ASA (0–3280 ng/mL), measured on three platelet function analyzers (TEG®6s, Multiplate®, and VerifyNow®) and respective Effective Concentration (EC) levels EC10, EC50 and EC90 were calculated. Repeatability was assessed in a separate group of pooled blood samples (n = 10) spiked with ticagrelor at EC10, EC50 and EC90. ASA had no impact on ADP-activated channels for all three devices. TEG®6s was able to distinguish (p ≤ 0.05) between all ticagrelor EC zones; VerifyNow® and Multiplate® were able to distinguish between three and two zones, respectively. Multiplate® showed the largest window between EC10 and EC90 (19–9153 ng/mL), followed by TEG®6s (144–2589 ng/mL), and VerifyNow® (191–1100 ng/mL). Drug effect models distribution of disagreements were identified for TEG®6s (5.0%), VerifyNow® (8.3%), and Multiplate® (13.3%). TEG®6s showed the smallest average coefficient of variation between EC conditions (5.1%), followed by Multiplate® (14.1%), and VerifyNow® (17.7%). Linear models could be generated between TEG®6s and Multiplate®, but not VerifyNow®. Significant differences were found between whole blood point-of-care platelet function analyzers and the clinical impact of these differences needs to be further investigated.

Impaired platelet function and peripartum bleeding in women with Gaucher disease

2011 ◽  
Vol 105 (03) ◽  
pp. 509-514 ◽  
Author(s):  
Michal Simchen ◽  
Rotem Oz ◽  
Boris Shenkman ◽  
Ari Zimran ◽  
Deborah Elstein ◽  
...  
Keyword(s):  
Platelet Function ◽  
Gaucher Disease ◽  
Enzyme Treatment ◽  
Study Cohort ◽  
Platelet Function Tests ◽  
Enzyme Replacement ◽  
Function Tests ◽  
Increased Risk ◽  
Type 1 Gaucher Disease

SummaryThe risk of bleeding during delivery may be increased in women with Gaucher disease. We aimed to evaluate potential predictors for peripartum haemorrhage (PPH) during childbirth in these patients, while focusing upon coagulation tests and platelet function assays. Women with type 1 Gaucher disease who gave birth at Sheba Medical Center between 1999–2009 comprised the study cohort. Data collected included disease history, enzyme treatment, platelet counts, delivery and pregnancy outcome. PPH was defined as excessive bleeding during or immediately following delivery. Coagulation studies and platelet function tests, including aggregometry and cone and platelet (CPA) analyses, were performed on all women. We compared women with PPH (bleeders) and non-bleeders. Furthermore, women with abnormal CPA platelet function tests were compared with those with normal CPA platelet function with regards to the risk for PPH in at least one pregnancy. Forty-five pregnancies of 20 women were studied. Six women received enzyme replacement therapy during pregnancy. Mean platelet count prior to delivery was 83,000/μl ± 35,000/μl. Fourteen out of 45 (31%) deliveries were complicated by PPH. Neither thrombocytopenia nor enzyme therapy predicted PPH. Twelve out of 13 women with PPH (92.3%) versus 2/7 non-bleeders (28.6%) had impaired platelet aggregation (less than the 3rd percentile of normal average aggregate size values), when tested by CPA, (odds ratio [OR] 17.8, 95% confidence interval [CI] 2.5; 126.2; p=0.007). Notably, 78.6% of women with impaired CPA aggregation developed PPH during at least one delivery, as opposed to 16.7% of those with normal CPA platelet function tests (OR 11.6, 95% CI 1.7–77.7, p=0.018). In conclusion, women with type 1 Gaucher disease who have abnormal platelet function tests may have an increased risk of PPH.

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