Next article Search Articles Instructions for authors  Access Statistics | Citation Manager  
ORIGINAL ARTICLE  

 Article Access Statistics
    Viewed3239    
    Printed84    
    Emailed4    
    PDF Downloaded253    
    Comments [Add]    
    Cited by others 6    

Recommend this journal

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


1 Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP
2 Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP
3 Institute of Life Science, College of Medicine, Swansea, SA2 8PP, United Kingdom

Correspondence Address:
Pankaj Kumar Mishra
Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.148321

Clinical trial registration ISRCTN43298975

Rights and Permissions

Year : 2015  |  Volume : 18  |  Issue : 1  |  Page : 45-51

 

SEARCH
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles

  Article in PDF (750 KB)
Email article
Print Article
Add to My List
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/).






[FULL TEXT] [PDF]*
 

 

 

 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 
 
 Reader Comments
 Email Alert *
  *
 * Requires registration (Free)
 
 ORIGINAL ARTICLE
 




1 Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP
2 Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre, Wolverhampton, United Kingdom WV10 0QP
3 Institute of Life Science, College of Medicine, Swansea, SA2 8PP, United Kingdom

Correspondence Address:
Pankaj Kumar Mishra
Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.148321

Clinical trial registration ISRCTN43298975

Rights and Permissions

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/).






[FULL TEXT] [PDF]*


        
Print this article     Email this article