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

OBJECTIVE: 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...

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Autores principales: Mishra, Pankaj Kumar, Thekkudan, Joyce, Sahajanandan, Raj, Gravenor, Mike, Lakshmanan, Suresh, Fayaz, Khazi Mohammed, Luckraz, Heyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900327/
https://www.ncbi.nlm.nih.gov/pubmed/25566711
http://dx.doi.org/10.4103/0971-9784.148321
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author Mishra, Pankaj Kumar
Thekkudan, Joyce
Sahajanandan, Raj
Gravenor, Mike
Lakshmanan, Suresh
Fayaz, Khazi Mohammed
Luckraz, Heyman
author_facet Mishra, Pankaj Kumar
Thekkudan, Joyce
Sahajanandan, Raj
Gravenor, Mike
Lakshmanan, Suresh
Fayaz, Khazi Mohammed
Luckraz, Heyman
author_sort Mishra, Pankaj Kumar
collection PubMed
description OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Study registration: ISRCTN43298975 (http://www.controlled-trials.com/ISRCTN43298975/).
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spelling pubmed-49003272016-06-16 The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting Mishra, Pankaj Kumar Thekkudan, Joyce Sahajanandan, Raj Gravenor, Mike Lakshmanan, Suresh Fayaz, Khazi Mohammed Luckraz, Heyman Ann Card Anaesth Original Article OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Study registration: ISRCTN43298975 (http://www.controlled-trials.com/ISRCTN43298975/). Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4900327/ /pubmed/25566711 http://dx.doi.org/10.4103/0971-9784.148321 Text en Copyright: © 2015 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mishra, Pankaj Kumar
Thekkudan, Joyce
Sahajanandan, Raj
Gravenor, Mike
Lakshmanan, Suresh
Fayaz, Khazi Mohammed
Luckraz, Heyman
The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title_full The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title_fullStr The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title_full_unstemmed The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title_short The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
title_sort role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900327/
https://www.ncbi.nlm.nih.gov/pubmed/25566711
http://dx.doi.org/10.4103/0971-9784.148321
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