Time-dependent changes in intraplatelet signaling pathways relevant to platelet function defect after cardiac surgery with cardiopulmonary bypass

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.

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Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Transfusion Medicine ◽

10.1111/tme.12678 ◽

2020 ◽

Vol 30 (5) ◽

pp. 369-376 ◽

Cited By ~ 1

Author(s):

Gunilla Kjellberg ◽

Manne Holm ◽

Gabriella Lindvall ◽

Gunilla Gryfelt ◽

Jan Linden ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Platelet Transfusion

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Effect of Cardiopulmonary Bypass Machine on the Platelet Function Testing.

10.21203/rs.3.rs-45350/v1 ◽

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.

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Inhaled prostacyclin and platelet function after cardiac surgery and cardiopulmonary bypass

Intensive Care Medicine ◽

10.1007/s001340050044 ◽

2000 ◽

Vol 26 (2) ◽

pp. 188-194 ◽

Cited By ~ 35

Author(s):

Å. Haraldson ◽

N. Kieler-Jensen ◽

H. Wadenvik ◽

S. -E. Ricksten

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Inhaled Prostacyclin

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Shear-Induced Pathway of Platelet Function in Cardiac Surgery

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0032-1313605 ◽

1995 ◽

Vol 21 (S 02) ◽

pp. 66-70 ◽

Cited By ~ 2

Author(s):

Noriyuki Tabuchi ◽

Izaak Tigchelaar ◽

Willem Van Oeveren

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Chest Drain ◽

Clotting Time ◽

Platelet Dysfunction ◽

Excessive Bleeding ◽

Activated Clotting Time ◽

Proper Diagnosis

The contribution of platelet dysfunction to the impaired hemostasis after cardiac surgery remains to be established, because there is no sensitive method to assess platelet function. Measurement of the shear-induced pathway of platelet function, an important mechanism in inducing hemostasis, became possible by a novel shear-inducing technique, the in-vitro bleeding test (Thrombostat 4000). By using this test, the changes in platelet function during cardiopulmonary bypass and their contribution to hemostasis were investigated in patients undergoing cardiac surgery. Platelet function is quickly impaired shortly after the start of cardiopulmonary bypass, and partly recovered at the end of cardiopulmonary bypass. The function of aspirin-treated platelets is more severely affected than of nonaspirin platelets during cardiopulmonary bypass. Furthermore, the degree of platelet dysfunction at the end of the operation, but neither the platelet number nor the activated clotting time, was significantly correlated with blood loss from the chest drain after cardiac surgery. These results indicate the significant and variable effects of cardiopulmonary bypass on the shear-induced pathway of platelet function. Moreover, the impairment of this function of platelets appears to be a major cause of excessive bleeding in patients after cardiac surgery. Therefore, the routine use of the shear-inducing test seems helpful to make a proper diagnosis and design the therapy for bleeders after cardiac surgery.

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Platelet function during cardiac surgery and cardiopulmonary bypass with low-dose aprotinin

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/s1053-0770(99)90207-0 ◽

1999 ◽

Vol 13 (4) ◽

pp. 382-387 ◽

Cited By ~ 13

Author(s):

Misericordia Basora ◽

Carmen Gomar ◽

Gines Escolar ◽

Mauricio Pacheco ◽

Guillermina Fita ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Low Dose

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Alterations Of Hemostasis During Cardiopulmonary Bypass (CPB): A Comparison Between Membrane And Bubble Oxygenators

10.1055/s-0038-1653187 ◽

1981 ◽

Author(s):

R L Bick ◽

N R Arbegast ◽

W R Schmalhorst

Keyword(s):

Cardiopulmonary Bypass ◽

Platelet Function ◽

Coronary Artery Bypass Surgery ◽

Degradation Products ◽

Artery Bypass ◽

Membrane System ◽

Platelet Dysfunction ◽

Significant Correction ◽

Function Defect ◽

Membrane Oxygenators

Alterations of hemostasis during cardiopulmonary bypass (CPB) using bubble oxygenators have been previously defined and found to consist of a severe platelet function defect, a primary hyperfibrino(geno)lytic syndrome, and minimal thrombocytopenia. This study compares defects in hemostasis with membrane oxygenators and bubble oxygenators. 30 consecutive patients were studied and all patients studied were undergoing elective coronary artery bypass surgery. Tests of hemostasis included thrombin and reptilase times, protamine corrected thrombin times, soluble fibrin monomer, fibrinogen degradation products, fibrinolytic assays, platelet counts, and tests of platelet function. Studies were drawn pre-bypass, mid-bypass, and 1 hour post bypass. It was found that thrombocytopenia was much less in membrane patients. All patients developed a primary hyperfibrino(geno)lytic syndrome and the degree of this was equal in bubble or membrane oxygenators. Platelet dysfunction also was seen in all patients but was significantly different between the two oxygenation systems. At one hour postop, membrane patients showed no correction of platelet function as assessed by adhesion (14%), while those perfused with bubble oxygenators showed significant correction (67%) at one hour postop.In conclusion, the primary hyperfibrino(geno)lytic syndrome occurring during cardiopulmonary bypass appears to be of equal significance regardless of oxygenation mechanism. Less thrombocytopenia, but more platelet dysfunction is seen with the membrane system.

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Platelet Function Changes in Different Cardiac Surgery Subgroups as Evaluated with an Innovative Technology

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e318158ccc8 ◽

2007 ◽

Vol 2 (4) ◽

pp. 176-183 ◽

Cited By ~ 1

Author(s):

Rabin Gerrah ◽

Alex Brill ◽

David Varon

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Surface Coverage ◽

Impact Test ◽

Postoperative Bleeding ◽

Innovative Technology ◽

Off Pump ◽

Platelet Aggregates ◽

The Impact

Objectives During cardiac surgery, platelets undergo substantial changes. The purpose of this study was to assess platelet function and compare these changes between different cardiac operations using an innovative technology. Methods Perioperative platelet function was evaluated by the Impact test [cone and plate(let) analyzer (CPA)]. The Impact test yields 2 parameters for platelet function: average size (AS, the mean size of the platelet aggregates) and surface coverage (SC, the percentage of the surface covered by the platelet aggregates), which correspond to platelet aggregation and adhesion. The study groups were compared for platelet function results in various surgery stages and correlation with bleeding. Results A significant decrease in surface coverage was detected on establishment of cardiopulmonary bypass, with an increase up to preoperative values at the end of the surgery in all groups. In contrast to operations performed on bypass, in patients operated without cardiopulmonary bypass, the postoperative AS and SC were higher than the preoperative values, 30.4 ± 8.1 μmol2 versus 23.3 ± 6.9 μmol2, P = 0.02 in AS, and 7.6 ± 3.6% versus 5.2 ± 1.8%, P = 0.04 in SC Preoperative AS and SC were the only parameters significantly (P = 0.01) and linearly (r = 0.6) related to postoperative bleeding. Conclusions Preoperative platelet function, as evaluated by the CPA, is an independent risk factor determining postoperative bleeding. The off-pump patients presented an increased platelet function at the end of surgery, a finding that can imply a higher risk of thrombosis. The impact test appears to be a useful tool to determine perioperative platelet function and help in prediction of postoperative bleeding.

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