An Evaluation of Cyclooxygenase-1 Inhibition Before Coronary Artery Surgery: Aggregometry Versus Patient Self-Reporting

Rahe‐Meyer, Niels; Winterhalter, Michael; Hartmann, Julia; Pattison, A.; Hecker, Hartmut; Calatzis, Andreas; Solomon, Cristina

doi:10.1213/ane.0b013e3181865733

Cited by 41 publications

(26 citation statements)

References 25 publications

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“…In addition, comparison studies showed only poor agreement between different methods for analyzing platelet function [13,34]. Although the usefulness of questionnaires for aspirin compliance and predicting bleeding during cardiac surgery has been reported [35], such self-reporting may not be fully reliable [6]. However, non-compliance of some patients would not explain changes in the test results before and after PTS transport and, therefore, does not question the study results.…”

Section: Discussionmentioning

confidence: 99%

“…Impedance aggregometry was performed on a Multiplate TM analyzer (Dynabite) according to the manufacturer's instructions. This system has been previously described in detail [6,7,13,14]. Briefly, it measures increases in impedance between electrodes caused by platelet aggregation.…”

Section: Impedance Platelet Aggregometrymentioning

confidence: 99%

“…In contrast to conventional platelet aggregometry in platelet-rich plasma, which is laboratory-based, time-consuming and operatordependent, a novel impedance platelet aggregometry in whole blood can be performed as a point-of-care assay without additional spinning. Such a system (Multiplate TM , Dynabite, Munich, Germany) has been shown to be valuable to assess the effects of aspirin in patients undergoing CABG surgery [6,7]. However, it is not known whether impedance aggregometry measured at the bedside and in a central laboratory provides the same results, as the personnel may have a differing levels of experience, quality control may be variable and a potential difference in time delay between specimen sampling and test performance [8].…”

Section: Introductionmentioning

confidence: 99%

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Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry

Bolliger¹,

Seeberger²,

Tanaka³

et al. 2009

Platelets

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Point-of-care platelet monitoring is increasingly used in cardiac patients treated with antiplatelet agents. The validity of a new assay needs to be evaluated not only for reproducible data in clinical samples, but also for other pre-analytical conditions that may influence measurements. The aim of this study was to evaluate the influence of a pneumatic tube system (PTS) for specimen transport on impedance platelet aggregometry. We evaluated 50 consecutive patients scheduled for coronary artery bypass surgery under oral therapy with 100 mg/d acetylsalicylic acid (aspirin). In each patient, three blood samples for platelet function analysis were taken before induction of anesthesia. The first sample was measured in the operating room (OR) area and designated as the reference value. The second sample was again measured by the same operator in the OR area using a random PTS transport. The third sample was sent to the central laboratory by PTS where it was measured by a local technician. Platelet function was assessed in whole blood by impedance aggregometry with a Multiplate analyzer using thrombin-related activation peptide (TRAP test) and arachidonic acid (ASPI test) (Dynabite GmbH, Munich, Germany). Mean +/- SD for TRAP test was 1009 +/- 196 in the reference measurement. Bias +/- 95% limit of agreement between the reference measurement and a second measurement for TRAP test were 126 +/- 284 (n = 25) for untransported and 181 +/- 316 (n = 25) for PTS transported samples. In the reference measurements, 48/50 (96%) of TRAP values were within the normal range. After PTS transport, 35/50 (70%) of TRAP measurements in the central laboratory were within the normal range (p < 0.001). Mean +/- SD for ASPI test was 175 +/- 137. Bias +/- 95% limit of agreement for ASPI test were 12 +/- 109 (n = 25) for untransported and 68 +/- 250 (n = 25) for PTS transported samples. In the reference measurements, 7/50 (14%) ASPI values were above the cut-off level and defined as reduced aspirin responsiveness. After PTS transport, only 1/50 (2%) of the patients showed reduced aspirin responsiveness in the central laboratory measurements (p = 0.031). In conclusion, PTS transport had a significant influence on platelet function testing by the Multiplate() analyzer. Significantly fewer test results indicated normal platelet function in TRAP test and reduced aspirin responsiveness in ASPI test after PTS transport. Therefore, clinical decisions regarding platelet function and aspirin responsiveness should not be based on blood specimens transported by a PTS system.

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Section: Discussionmentioning

confidence: 99%

Section: Impedance Platelet Aggregometrymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry

Bolliger¹,

Seeberger²,

Tanaka³

et al. 2009

Platelets

View full text Add to dashboard Cite

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“…The test has also been found to be able to detect impaired hemostasis after CPB surgery [35][36][37] and to identify patients before and after cardiac surgery with enhanced risk of bleeding and of blood transfusion 38,39 .…”

Section: The Influence Of Omega-3 Pufas In Cpb Procedures On the Activmentioning

confidence: 99%

Effect of pretreatment with omega-3 polyunsaturated fatty acids (PUFAs) on hematological parameters and platelets aggregation in patients during elective coronary artery bypass grafting

et al. 2013

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This prospective, randomized, placebo-controlled, single-center trial was performed on parallel groups. The patients (n = 40) undergoing elective CABG were randomized receivin preoperative intravenous omega-3 PUFAs (Omegaven 10%) infusion (the PUFAs group) or the same volume of 0.9% saline solution infusion (the control group). Infusion was given a day before surgery and repeated four hours before starting extracorporeal circulation (CPB) via the pe ripheral vein at single doses of 100 mL (25 mL/h). Platelet function analysis was performed using multiple electrode aggregometry (MEA, multiplate-analyzer) before starting CPB and 2 h postoperatively for the patients of both groups. Results. There were no clinically relevant differ ences in baseline characteristics between the groups. He matological parameters were not significantly different between the groups pre-, intra- and postoperatively. Dur ing the first 24 h after surgery, the loss of blood was simi lar in the PUFAs and the control group (680 +/- 274 mL and 608 +/- 210 mL, respectively; p = 0.356). Postopera tively, platelet aggregation was not significantly different between the PUFAs and the control group in adenosine diphosphate (ADP) test (39 +/- 11 and 42 +/- 15, respec tively; p = 0.701), arachidonic acid (ASPI) test (64 +/- 24 and 70 +/- 27, respectively; p = 0.525) and trombin receptor-activating peptide (TRAP) test (68 +/- 25 and 75 + 26, respectively; p = 0.396), while their aggregation in collagen (COL) test was statistically significantly lower in the PUFAs related to the control group (32 +/- 15 and 47 +/- 20, re spectively; p = 0.009). Conclusion. Acute pretreatment with omega-3 PUFAs insignificantly affected the activity of platelets and did not influence postoperative blood loss.

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“…In the past five years, MEA has become an important and widely used diagnostic tool for coagulation monitoring with respect to hereditary [8] and acquired [7,[9][10][11][12][13] platelet dysfunction, as well as surveillance of platelet inhibitor effects [14][15][16][17][18][19], as shown by many studies. Taking less than 10 minutes, MEA allows conclusions to be drawn about the patient's platelet function from standardized test procedures that are easy to perform.…”

Section: Introductionmentioning

confidence: 99%

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

et al. 2012

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Pneumatic tube systems (PTS) present a convenient way for blood sample transport in medical facilities. Associated preanalytical interference in various tests is largely unknown. Implementing point-of-care coagulation management at our institution, we investigated multiple electrode aggregometry (MEA) and rotational thromboelastometry (ROTEM) after PTS transportation. Whole blood samples from patients undergoing general or trauma surgery were analysed by MEA after collection (baseline, '0 × PTS') and sent on a predefined PTS track (n = 12). MEA was repeated after samples travelled the track 4 ('4 × PTS'), 8 ('8 × PTS') and 12 times ('12 × PTS') and compared with stationary controls analysed at the same time. Samples for ROTEM (n = 6) were analysed after collection and travelling the track 12 times. An acceleration detector recorded g-forces on the PTS track. At '0 × PTS' no significant differences in MEA results were detected. Values were significantly lower for transported samples compared with controls ('4 × PTS' to '12 × PTS', p < 0.001). Furthermore, MEA results of PTS samples were significantly decreased for '4 × PTS' to '12 × PTS' compared to baseline (p < 0.001). Except for the clotting time in EXTEM PTS transport did not significantly alter results for investigated ROTEM parameters, compared with baseline and stationary controls. Acceleration detector readout revealed alternating g-forces between -6.3 and +5.9 during transport. PTS transport caused invalid results in MEA while only one ROTEM parameter was found to be affected in this study. Variable acceleration during transport provides a potential reason for platelet activation. The authors recommend sample transport by hand or the device to be placed patient-side when MEA is performed.

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An Evaluation of Cyclooxygenase-1 Inhibition Before Coronary Artery Surgery: Aggregometry Versus Patient Self-Reporting

Abstract: Our results suggest that arachidonic acid-induced aggregation in whole blood may be a better predictor of platelet-related coagulopathy and platelet transfusion than the assessment of aspirin intake by patient self-reporting.

Cited by 41 publications

References 25 publications

Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry

Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry

Effect of pretreatment with omega-3 polyunsaturated fatty acids (PUFAs) on hematological parameters and platelets aggregation in patients during elective coronary artery bypass grafting

Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry

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