The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting

• Published in: Annals of cardiac anaesthesia Vol. 18; no. 1; pp. 45 - 51
• Main Authors: Mishra, Pankaj Kumar, Thekkudan, Joyce, Sahajanandan, Raj, Gravenor, Mike, Lakshmanan, Suresh, Fayaz, Khazi Mohammed, Luckraz, Heyman
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2015; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Analysis; Anti-platelet therapy; Bleeding; Coronary artery bypass grafting; Multiplate; Platelet Dysfunction; Platelet function assessment; Blood platelets; Blood Transfusion - methods; Blood Transfusion - statistics & numerical data; Cardiovascular disease; Care and treatment; Complications and side effects; Coronary artery bypass; Coronary Artery Bypass - methods; Coronary vessels; Cost control; Endpoint Determination; Female; Health aspects; Heart surgery; Hematologic diseases; Humans; Male; Middle Aged; Original; Platelet Function Tests - methods; Platelet-rich plasma therapy; Point-of-Care Systems; Postoperative Care - methods; Postoperative Hemorrhage - diagnosis; Postoperative period; Predictive Value of Tests; Preoperative Care; Prospective Studies; Quality of life; Risk factors; Thrombelastography; Thrombosis; India
• ISSN: 0971-9784; 0974-5181
• DOI: 10.4103/0971-9784.148321

OBJECTIVE platelet function assessment after cardiac surgery can predict postoperative blood loss, guide transfusion requirements and discriminate the need for surgical re-exploration. We conducted this study to assess the predictive value of point-of-care testing platelet function using the Multiplate® device. Patients undergoing isolated coronary artery bypass grafting were prospectively recruited ( n = 84). Group A ( n = 42) patients were on anti-platelet therapy until surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at least 5 days preoperatively. Multiplate® and thromboelastography (TEG) tests were performed in the perioperative period. Primary end-point was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative. Secondary end-points included transfusion requirements, re-exploration rates, intensive care unit and in-hospital stays. Patients in Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher re-exploration rates (14% vs. 0%, P < 0.01) and higher rate of blood (41% vs. 14%, P < 0.01) and platelet (14% vs. 2%, P = 0.05) transfusions. On multivariate analysis, preoperative platelet function testing was the most significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P = 0.08), need for blood (OR: 5.5, P < 0.01) and platelet transfusion (OR: 15.1, P < 0.01). Postoperative "ASPI test" best predicted the need for transfusion (sensitivity - 0.86) and excessive blood loss (sensitivity - 0.81). TEG results did not correlate well with any of these outcome measures. Peri-operative platelet functional assessment with Multiplate® was the strongest predictor for bleeding and transfusion requirements in patients on anti-platelet therapy until the time of surgery.