Clinical Relevance and Practical Value of Platelet Function Assessment Using Multiple Electrode Aggregometry during Extracorporeal Circulation

Multiple causes (pseudothrombocytopenia, hemodilution, increased consumption, decreased production, increased sequestration, and immune-mediated destruction of platelets) alone or in combination make thrombocytopenia very common in intensive care unit (ICU) patients. Persisting thrombocytopenia in critically ill patients is associated with, but not causative of, increased mortality. Identification of the underlying cause is key for management decisions in individual patients. While platelet transfusion might be indicated in patients with impaired platelet production or increased platelet destruction, it could be deleterious in patients with increased intravascular platelet activation. Sepsis and trauma are the most common causes of thrombocytopenia in the ICU. In these patients, treatment of the underlying disease will also increase platelet counts. Heparin-induced thrombocytopenia requires alternative anticoagulation at a therapeutic dose and immune thrombocytopenia immunomodulatory treatment. Thrombocytopenia with symptomatic bleeding at or above World Health Organization grade 2 or planned invasive procedures are established indications for platelet transfusions, while the evidence for a benefit of prophylactic platelet transfusions is weak and controversial. If the platelet count does not increase after transfusion of 2 fresh ABO blood group–identical platelet concentrates (therapeutic units), ongoing platelet consumption and high-titer anti-HLA class I antibodies should be considered. The latter requires transfusion of HLA-compatible platelet concentrates.

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Analyzes of antiplatelets and anticoagulants utilization in patients treated in cardiovascular rehabilitation center from Croatia

Boban¹,

Peršić²,

Peša³

et al. 2016

SANAMED

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Purpose: Discordance with the guidelines and underutilization of pharmacotherapy for secondary prevention frequently exists in clinical practice. Aim of our study was to assess the prescription routine and drug utilization patterns for antiplatelets and peroral anticoagulants in tertiary medical center specialized for cardiovascular rehabilitation.Methods: study included 96 consecutive patients scheduled for cardiovascular rehabilitation in period 1-6 months after the acute treatment for ischemic 87 (80.2%) and valvular heart disease 18 (19.8%). Patients were divided according to etiology of heart disease and type of acute cardiovascular treatments (conservative, percutaneous coronary interventions (PCI) and surgery).Results: Dual antiplatelet therapy was the most commonly applied regimen in 84 (87.5%) of conservatively treated myocardial infarctions, 47 (61.9%) of percutaneous coronary interventions (PCI) and 13 (58.9%) of surgically treated group (p > 0.05). Among studied group of patients significant differences in utilization were found for warfarin, or combinations of antiplatelets with warfarin (p < 0.001), as well as studied etiologies of heart disease (p < 0.001), whilst there were no differences for those groups for studied antiplatelets drugs (p > 0.05). All four of patients that received triple therapy (4.17%) were from surgical group. Underutilization of antiplatelets in ischemic heart disease was at 11 (14.3%) what was congruent with the developed industrial nations.Conclusions: Acute cardiovascular treatment type, but not heart disease etiology, had significant influence on subsequent prescription routine. Decreased use of pharmacological agents for secondary prevention in surgical patients was revealed. Drug utilization analyzes can offer improvement in optimizing medical treatments, quality of care and decrease unnecessary polypragmasia, as well as improve economical efficiency of medical management.

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Clinical Relevance and Practical Value of Platelet Function Assessment Using Multiple Electrode Aggregometry during Extracorporeal Circulation

Cited by 3 publications

References 6 publications

Hematologic Issues in Sepsis

Hematologic Issues in Sepsis

How I evaluate and treat thrombocytopenia in the intensive care unit patient

Analyzes of antiplatelets and anticoagulants utilization in patients treated in cardiovascular rehabilitation center from Croatia

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