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.

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.

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

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.

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 350-362 ◽  
Author(s):  
Idris Ghijselings ◽  
Dirk Himpe ◽  
Steffen Rex
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Postoperative Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

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

Shear-Induced Pathway of Platelet Function in Cardiac Surgery

1995 ◽  
Vol 21 (S 02) ◽  
pp. 66-70 ◽  
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.

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

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.

scholarly journals Effect of Cardiopulmonary Bypass on Regional Antibiotic Penetration into Lung Tissue

2013 ◽  
Vol 57 (7) ◽  
pp. 2996-3002 ◽  
Author(s):  
D. Hutschala ◽  
K. Skhirtladze ◽  
C. Kinstner ◽  
M. Zeitlinger ◽  
W. Wisser ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Lung Tissue ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Opcab Group ◽  
Significant Difference ◽  
Lower Lung

ABSTRACTThe use of cardiopulmonary bypass (CPB) during cardiac surgery causes regional ventilation-perfusion mismatch, contributing to regional disturbances in antibiotic penetration into lung tissue. Ventilation-perfusion mismatch is associated with postoperative pneumonia, a frequent and devastating complication after cardiac surgery. In this prospective clinical animal study, we performedin vivomicrodialysis to determine the effect of CPB on regional penetration of levofloxacin (LVX) into lung tissue. Six pigs underwent surgery with CPB (CPB group), and another six pigs underwent surgery without CPB (off-pump coronary artery bypass grafting; OPCAB group). LVX (750 mg) was administered intravenously to all pigs immediately after surgery. For regional measurements of LVX in pulmonary concentrations, microdialysis probes were inserted in both lungs of each pig. Pigs were placed in the right lateral position. Time versus concentration profiles of unbound LVX were measured in the upper and lower lung tissue and plasma in all pigs. In all pigs, maximum concentrations (Cmax) of LVX were significantly lower in the upper lung than in the lower lung (OPCAB,P= 0.035; CPB,P< 0.001). MedianCmaxof LVX showed a significant difference in the upper versus lower lung in the CPB group (P< 0.05). No significant difference was found in the medianCmaxof LVX in the upper and the lower lung in the OPCAB group (P= 0.32). Our data indicate that CPB affects perioperative regional antibiotic penetration into lung tissue. Common clinical antibiotic dosing schemes should be reevaluated in patients undergoing coronary artery bypass grafting with CPB.

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

2007 ◽  
Vol 2 (4) ◽  
pp. 176-183 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document