scholarly journals Role of Platelet Function Test in Predicting Postoperative Bleeding Risk after Coronary Artery Bypass Grafting: A Prospective Observational Study

2021 ◽  
Author(s):  
Sandeep Sharan ◽  
Poonam Malhotra Kapoor ◽  
Minati Choudhury ◽  
V Devagourou ◽  
Ujjwal Kumar Choudhury ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Cardiac Surgery ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Adenosine Diphosphate ◽  
Blood Component ◽  
Platelet Function Test ◽  
Excessive Bleeding ◽  
Maximum Slope

AbstractPatients undergoing cardiac surgery are at risk of excessive bleeding and its 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 reexploration are 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. In the Arachidonic Acid Thromboelastometry (ARATEM) test, platelets are activated with arachidonic acid; in Adenosine diphosphate Thromboelastometry (ADPTEM) test, platelets are activated with adenosine diphosphate; and in TRAPTEM test, platelets are activated with thrombin receptor-activating peptide 6. Measurement time is 6 minutes, and results are expressed in three different parameters: A6 (amplitude at 6 minutes, in Ohm); MS (maximum slope of the aggregation curve in Ohm/min), and AUC (area under the curve in Ohm.min). Algorithm-based point-of-care platelet function testing helped us to preemptively give the right blood component therapy, avoiding fibrinolytic bleeding in the postoperative period.

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

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.

Abstract 4023: Aspirin “Resistance”: Role of Pre-existent Platelet Reactivity and Correlation Between Tests

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andrew L Frelinger ◽  
Youfu Li ◽  
Matthew D Linden ◽  
Inge Tarnow ◽  
Marc R Barnard ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Platelet Aggregation ◽  
Platelet Function ◽  
Normal Subjects ◽  
Aspirin Resistance ◽  
The Other ◽  
List Type ◽  
Platelet Function Test ◽  
Function Test

Background: Aspirin “resistance” (i.e. hyporesponsiveness to aspirin in a platelet function test) has been widely reported, but the underlying mechanism is unclear. We examined the role of pre-existent platelet hyperreactivity in aspirin “resistance”. We also determined the correlation between aspirin resistance defined by serum thromboxane (TX) B 2 (the most specific test of aspirin’s effect) and other assays of platelet function. Methods: Platelet function measured before and after aspirin 81 mg daily for 7 days was analyzed by Spearman’s rank correlation. Normal subjects (n=165) were studied because virtually all clinically relevant patients are already taking aspirin. An additional advantage of the use of normal subjects is that the platelet response to stimuli is not influenced (with resultant increased scatter of the data) by an underlying disease, e.g. coronary artery disease, which causes platelet hyperreactivity. Results: The proportion of the post-aspirin platelet function predicted by the pre-aspirin platelet function was 28.3 ± 7.5% (mean ± asymptotic standard error) for serum TXB 2 , 39.3 ± 6.8% for urinary 11-dehydro TXB 2 , 4.4 ± 7.7% for arachidonic acid-induced platelet aggregation, 40.4 ± 7.1% for ADP-induced platelet aggregation, 26.3 ± 9.2% for the VerifyNow Aspirin Assay®, and 45.0 ± 10.9% for the TEG® PlateletMapping ™ System with arachidonic acid. Spearman rank order correlations were highly significant for comparisons between assays when both pre-aspirin and post-aspirin results were included in the analysis. However, residual serum TXB 2 levels post-aspirin treatment were not significantly associated with post-treatment results of any of the other assays. Platelet count correlated with pre-aspirin serum TXB 2 and VerifyNow Aspirin Assay, but not with any post-aspirin platelet function test. Conclusions: Aspirin “resistance” (i.e. hyporesponsiveness to aspirin in a laboratory test) is in part unrelated to aspirin but is the result of underlying platelet hyperreactivity prior to the institution of aspirin therapy. Individuals identified as aspirin “resistant” defined by serum TXB 2 are not the same individuals identified by the other tests.

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.

Effects of acepromazine maleate on platelet function assessed by use of adenosine diphosphate activated– and arachidonic acid– activated modified thromboelastography in healthy dogs

2012 ◽  
Vol 73 (5) ◽  
pp. 595-601 ◽  
Author(s):  
Bobbi J. Conner ◽  
Rita M. Hanel ◽  
Bernard D. Hansen ◽  
Alison A. Motsinger-Reif ◽  
Makoto Asakawa ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Platelet Function ◽  
Adenosine Diphosphate ◽  
Healthy Dogs

scholarly journals Effect of alteplase on platelet function and receptor expression

2019 ◽  
Vol 47 (4) ◽  
pp. 1731-1739 ◽  
Author(s):  
Jun Lu ◽  
Peng Hu ◽  
Guangyu Wei ◽  
Qi Luo ◽  
Jianlin Qiao ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Platelet Aggregation ◽  
Platelet Activation ◽  
Platelet Function ◽  
Adenosine Diphosphate ◽  
Receptor Expression ◽  
Light Transmittance ◽  
Dependent Manner ◽  
Clot Retraction ◽  
Platelet Receptors

Objective To investigate the role of alteplase, a widely-used thrombolytic drug, in platelet function. Methods Human platelets were incubated with different concentrations of alteplase followed by analysis of platelet aggregation in response to adenosine diphosphate (ADP), collagen, ristocetin, arachidonic acid or epinephrine using light transmittance aggregometry. Platelet activation and surface levels of platelet receptors GPIbα, GPVI and αIIbβ3 were analysed using flow cytometry. The effect of alteplase on clot retraction was also examined. Results This study demonstrated that alteplase significantly inhibited platelet aggregation in response to ADP, collagen and epinephrine in a dose-dependent manner, but it did not affect ristocetin- or arachidonic acid-induced platelet aggregation. Alteplase did not affect platelet activation as demonstrated by no differences in P-selectin levels and PAC-1 binding being observed in collagen-stimulated platelets after alteplase treatment compared with vehicle. There were no changes in the surface levels of the platelet receptors GPIbα, GPVI and αIIbβ3 in alteplase-treated platelets. Alteplase treatment reduced thrombin-mediated clot retraction. Conclusions Alteplase inhibits platelet aggregation and clot retraction without affecting platelet activation and surface receptor levels.

scholarly journals The Use of Point-of-care Testing in Detecting Platelet Function Recovery in a Patient Treated with Prasugrel Undergoing Urgent Surgical Revascularization

2021 ◽  
Author(s):  
Alessandra Verzelloni Sef ◽  
Francesca Caliandro ◽  
Davorin Sef ◽  
Shahzad Raja
Keyword(s):  
Platelet Function ◽  
Waiting Time ◽  
Point Of Care ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Function Recovery ◽  
Patients At Risk ◽  
Function Testing

A recent administration of potent P2Y12 receptor inhibitor such as prasugrel in patients undergoing cardiac surgery remains a dilemma and little is known about its impact on platelet function recovery. Guidelines recommend discontinuation of prasugrel 7 days before surgery to reduce the risk of surgery-related bleeding. Patients at risk may benefit from preoperative platelet function testing to guide individualized preoperative waiting time. We present a rare case of complete function recovery in a patient treated with prasugrel revealed by preoperative platelet function monitoring before urgent coronary artery bypass surgery (CABG). A complete platelet function recovery was revealed by platelet function testing after discontinuation of prasugrel for four days and patient underwent urgent CABG without increased risk of postoperative bleeding. Our case with a review of literature emphasized that the decision to proceed with urgent CABG in a patient recently treated with prasugrel should be based on a personalized risk assessment and might be supported by preoperative platelet function monitoring to shorten the waiting time.

Post-Operative Outcomes of Off-Pump Coronary Artery Bypass Surgery Patients after Topical Use of Tranexamic Acid

2017 ◽  
Vol 2 (2) ◽  
pp. 79-83
Author(s):  
Asraful Hoque ◽  
Asit Baran Adhikary ◽  
KAM Mahbub Hasan ◽  
Romena Rahman ◽  
Mauin Uddin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Pericardial Cavity ◽  
Significant Difference ◽  
Opcab Surgery ◽  
Group 2 ◽  
Topical Tranexamic Acid ◽  
Group 1

Background: Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: This study was intended to investigate the efficacy of topical tranexamic acid in reducing postoperative bleeding after OPCAB surgery. Methodology: This non-randomized, double blinded, clinical trial was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during January 2014 to December 2015 for a period of two (2) years. Patients’ undergone CABG after fulfilling the inclusion and exclusion criteria was recruited for this study. They were assigned in two groups 30 patients in tranexamic acid group (Group 1) and 30 patients in placebo group (Group 2). On completion of the grafting, before closure of the sternum tranexamic acid (2.5 g/25 mL) or placebo (25 mL of saline) diluted in 100 mL of warm saline (37° C) was instilled into the pericardial cavity including the mediastinal tissues and left for 5 minutes. Then it was cleared out by wall sucker and sternum was closed. Result: There was no significant difference in baseline demographic data, basic clinical characteristics and preoperative coagulation profile between the 2 groups (P>0.05). Total mediastinal bleeding in group 1 and group 2 patients were 421.67±70.32 vs 593.33±77.38 ml (p<0.001). In case of, whole blood transfusion in group 1 and group 2 patients were 0.87±0.0.73 units and 1.77±0.57 units respectively (p<0.001). No patient required reoperation for bleeding and there was no incidence of prolonged ventilation, MI, thromboembolism, DVT or CVA in any of the patients in either group. Conclusion: In conclusion the efficacy of topical tranexamic acid is helpful for reducing postoperative bleeding after OPCAB surgery. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2): 79-83

scholarly journals Use of Factor VIIa and Anti-inhibitor Coagulant Complex in Pediatric Cardiac Surgery Patients

2020 ◽  
Vol 25 (6) ◽  
pp. 540-546
Author(s):  
Rachel B. Carroll ◽  
Hania Zaki ◽  
Courtney McCracken ◽  
Janet Figueroa ◽  
Nina A. Guzzetta
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Factor Viia ◽  
Postoperative Bleeding ◽  
Pediatric Cardiac Surgery ◽  
Coagulation System ◽  
Clotting Factor ◽  
Blood Products ◽  
Excessive Bleeding ◽  
Off Label

OBJECTIVES Postoperative bleeding is a common cause of morbidity and mortality in cardiac patients who undergo cardiopulmonary bypass (CPB). Pediatric patients are especially at risk for adverse effects of surgery and CPB on the coagulation system. This can result in bleeding, transfusions, and poor outcomes. Excessive bleeding unresponsive to blood products can warrant the off-label use of recombinant activated clotting factor VIIa (rFVIIa) and/or anti-inhibitor coagulant complex (FEIBA). Several studies have shown the utility in these agents off-label in patients who have undergone cardiac bypass surgery with acute bleeding episodes that are refractory to blood products. However, data regarding use of these agents in pediatrics are sparse. The purpose of this study is to report the use of rFVIIa and FEIBA in pediatric cardiac surgery patients in our institution. METHODS This was a retrospective chart review of pediatric cardiothoracic surgery patients who received rFVIIa or FEIBA at Children's Healthcare of Atlanta during the study period. RESULTS Thirty-three patients received rFVIIa and 9 patients received FEIBA either intraoperatively or postoperatively for bleeding related to the cardiac procedure. Approximately 13% of rFVIIa patients and 55% of FEIBA patients required repeat doses. There were decreases for all blood products administered after rFVIIa and FEIBA were given. However, the doses used did not correlate with either positive or negative outcomes. Seventeen percent (n = 7) of rFVIIa patients experienced a thrombus and 22% (n = 2) of FEIBA patients experienced a thrombus. CONCLUSIONS Both rFVIIa and FEIBA reduced blood product usage in pediatric patients following cardiac procedures.

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