The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting.
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Date
2015-01
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Abstract
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 (https://
www.controlled‑trials.com/ISRCTN43298975/).
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Keywords
Anti‑platelet therapy, Bleeding, Coronary artery bypass grafting, Multiplate, Platelet Dysfunction, Platelet function assessment
Citation
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. Annals of Cardiac Anaesthesia. 2015 Jan-Mar ; 18(1): 45-51.