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

IntroductionPlatelet dysfunction (thrombocytopathy) is a major problem in the bleeding patient and increases morbidity and healthcare costs. The thrombocytopathy resulting from cardiopulmonary bypass (CPB) can be used to study therapies targeted to improve outcomes in other scenarios, such as trauma. Platelet transfusion is used widely to correct thrombocytopathy. However, the current standard, room temperature stored platelets (RTP) have several disadvantages including; short shelf life, risk of bacterial contamination and deterioration in platelet function during storage. Cold stored platelets (CSP) are a potential alternative product with longer shelf life, reduced contamination risk and better-preserved platelet function.MethodsUsing ex vivo mixing studies, we investigated whether CSP were better able to reverse the thrombocytopathy associated with cardiac surgery than RTP. Blood samples were collected from 20 cardiac surgery patients. Donor platelets were split into two bags and stored at either 4°C (CSP), or 22°C (RTP) for up to seven days. The donor platelets were mixed with the patient blood samples to simulate platelet transfusion. The mixed samples were analysed using the TEG 5000 and using a collagen coated flow chamber at arterial shear. Patient samples were analysed alongside healthy controls (n = 20).ResultsAfter mixing the patient samples with CSP, the TEG R times were shorter than in samples mixed with RTP (p<0.0001), indicating more rapid initiation of clot formation. In the flow chamber experiments, the clot volume was greater in the patient samples mixed with CSP compared with samples mixed with RTP (p<0.0001).ConclusionsThese findings suggest that CSP, but not RTP can partially reverse the thrombocytopathy associated with cardiac surgery ex vivo, at clinically relevant mixing volumes. Reversal of thrombocytopathy by mixing CSP was greatest in the arterial shear model, which may indicate superior in vivo efficacy that requires confirmation in clinical trials.* this abstract presentation was awarded First Place.

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

Perfusion ◽

10.1177/0267659119866289 ◽

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.

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Restoration of platelet function with platelet transfusion in cardiac surgery patients on dual antiplatelet therapy

European Heart Journal ◽

10.1093/eurheartj/eht310.p4873 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4873-P4873 ◽

Cited By ~ 1

Author(s):

S. O'Connor ◽

M. Rejane ◽

J. Amour ◽

J. Abtan ◽

M. Kerneis ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Platelet Function ◽

Platelet Transfusion ◽

Dual Antiplatelet Therapy

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

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00328 ◽

2010 ◽

Vol 27 ◽

pp. 103

Author(s):

M. Murase ◽

Y. Nakajima ◽

D. Sessler ◽

M. Shibasaki ◽

T. Mizobe

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Signaling Pathways ◽

Platelet Function ◽

Time Dependent ◽

Function Defect

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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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Effects of fibrinogen and platelet transfusion on coagulation and platelet function in bleeding cardiac surgery patients

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13295 ◽

2018 ◽

Vol 63 (4) ◽

pp. 475-482 ◽

Cited By ~ 2

Author(s):

Caroline Shams Hakimi ◽

Sukhi Singh ◽

Camilla Hesse ◽

Anders Jeppsson

Keyword(s):

Cardiac Surgery ◽

Platelet Function ◽

Platelet Transfusion

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Platelet Function Changes during Neonatal Cardiopulmonary Bypass Surgery: Mechanistic Basis and Lack of Correlation with Excessive Bleeding

Thrombosis and Haemostasis ◽

10.1055/s-0039-1700517 ◽

2019 ◽

Vol 120 (01) ◽

pp. 094-106 ◽

Cited By ~ 2

Author(s):

Nicole M. J. Zwifelhofer ◽

Rachel S. Bercovitz ◽

Regina Cole ◽

Ke Yan ◽

Pippa M. Simpson ◽

...

Keyword(s):

Platelet Count ◽

Cardiopulmonary Bypass ◽

Platelet Activation ◽

Platelet Function ◽

Platelet Transfusion ◽

Adenosine Diphosphate ◽

Bleeding Complications ◽

Bleeding Events ◽

Excessive Bleeding ◽

Platelet Counts

AbstractThrombocytopenia and platelet dysfunction induced by extracorporeal blood circulation are thought to contribute to postsurgical bleeding complications in neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this study, we examined how changes in platelet function relate to changes in platelet count and to excessive bleeding in neonatal CPB surgery. Platelet counts and platelet P-selectin exposure in response to agonist stimulation were measured at four times before, during, and after CPB surgery in neonates with normal versus excessive levels of postsurgical bleeding. Relative to baseline, platelet counts were reduced in patients while on CPB, as was platelet activation by the thromboxane A2 analog U46619, thrombin receptor activating peptide (TRAP), and collagen-related peptide (CRP). Platelet activation by adenosine diphosphate (ADP) was instead reduced after platelet transfusion. We provide evidence that thrombocytopenia is a likely contributor to CPB-associated defects in platelet responsiveness to U46619 and TRAP, CPB-induced collagen receptor downregulation likely contributes to defective platelet responsiveness to CRP, and platelet transfusion may contribute to defective platelet responses to ADP. Platelet transfusion restored to baseline levels platelet counts and responsiveness to all agonists except ADP but did not prevent excessive bleeding in all patients. We conclude that platelet count and function defects are characteristic of neonatal CPB surgery and that platelet transfusion corrects these defects. However, since CPB-associated coagulopathy is multifactorial, platelet transfusion alone is insufficient to treat bleeding events in all patients. Therefore, platelet transfusion must be combined with treatment of other factors that contribute to the coagulopathy to prevent excessive bleeding.

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