Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery

Carroll, Roger C.; Chavez, Jack J.; Snider, Carolyn C.; Meyer, David S.; Muenchen, Robert A.

doi:10.1016/j.lab.2005.12.007

Cited by 50 publications

(36 citation statements)

References 17 publications

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“…Platelet mapping has the potential to evaluate the function of different platelet receptors in the presence of coagulation factors and fibrinogen mimicking conditions in patients. Cardiopulmonary bypass has multiple effects on coagulation and TEG parameters [7,17,25]. In our study, the effects of CPB were consistent with consumption of coagulation factors, fibrinogen and platelets.…”

Section: Discussionsupporting

confidence: 79%

“…The percentage platelet aggregation can also be applied to predict thrombotic complications in patients receiving antiplatelet therapy [15]. Previous studies have shown platelet mapping to be significantly correlated to optical platelet aggregation, validating its use as a point of care test for measuring platelet function [16][17][18]. The aim of this study was to investigate the effect of CPB on percentage platelet aggregation using ADP and AA, and also to determine whether testing with platelet mapping is predictive for blood loss.…”

mentioning

confidence: 99%

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Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Weitzel

Weitzel²,

Epperson³

et al. 2012

Anaesthesia

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Summary The platelet‐mapping assay of the thromboelastograph was used to measure platelet aggregation and to examine the effect of cardiopulmonary bypass on multiple platelet receptors and the role of altered receptor activity in postoperative bleeding. The percentage platelet aggregation for collagen, adenosine diphosphate and arachidonic acid was measured in 40 patients divided post‐hoc into high‐ or low‐bleeding groups depending on postoperative 24‐h chest tube output. Platelet aggregation was lower after cardiopulmonary bypass compared to before it using collagen (mean (SD) 45 (25) vs 19 (12) %, p < 0.001), adenosine diphosphate (76 (23) vs 35 (24) %, p < 0.001), and arachidonic acid (61 (33) vs 31 (35) %, p < 0.001). Only platelet aggregation as measured using collagen pre‐ and post‐cardiopulmonary bypass was significantly less in the high‐ compared to the low‐bleeding group. This finding was significantly correlated with the 24‐h chest tube drainage, and it predicted postoperative bleeding with a sensitivity of 83% and a specificity of 68%. Therefore, platelet aggregation is reduced following cardiopulmonary bypass, and this may play a role in predicting postoperative blood loss.

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Section: Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Weitzel

Weitzel²,

Epperson³

et al. 2012

Anaesthesia

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“…In the TEG Ò Platelet Mapping System An observational study in healthy volunteers taking aspirin or clopidogrel found it to be a rapid and reliable method to assess resulting timedependant platelet inhibition . A further study found the platelet mapping system to be extremely sensitive in detecting both the presence of and degree of platelet inhibition in vascular patients on aspirin and/or clopidogrel therapy (Carroll et al, 2006). There was good agreement between the results of conventional platelet aggregometry and TEG Ò Platelet Mapping (Agarwal et al, 2006).…”

Section: Platelet Function Testingmentioning

confidence: 97%

“…The ratio of the activated platelet count to the nonactivated platelet count is a function of platelet reactivity. There is no correlation between pre-operative platelet dysfunction as assessed by Plateletworks and post operative bleeding risk (Carroll et al, 2006).…”

Section: Poct: Platelet Functionmentioning

confidence: 98%

Point‐of‐care testing in haemostasis

Perry

Fitzmaurice

Kitchen³

et al. 2010

Br J Haematol

125

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SummaryPoint-of-care testing (POCT) in haematology has seen a significant increase in both the spectrum of tests available and the number of tests performed annually. POCT is frequently undertaken with the belief that this will reduce the turnaround time for results and so improve patient care. The most obvious example of POCT in haemostasis is the out-ofhospital monitoring of the International Normalized Ratio in patients receiving a vitamin K antagonist, such as warfarin. Other areas include the use of the Activated Clotting Time to monitor anticoagulation for patients on cardio-pulmonary bypass, platelet function testing to identify patients with apparent aspirin or clopidogrel resistance and thrombelastography to guide blood product replacement during cardiac and hepatic surgery. In contrast to laboratory testing, POCT is frequently undertaken by untrained or semi-trained individuals and in many cases is not subject to the same strict quality control programmes that exist in the central laboratory. Although external quality assessment programmes do exist for some POCT assays these are still relatively few. The use of POCT in haematology, particularly in the field of haemostasis, is likely to expand and it is important that systems are in place to ensure that the generated results are accurate and precise.Keywords: point-of-care testing, haemostasis, quality assurance, near patient testing.Point-of-care testing (POCT) is defined as a diagnostic test at or near the site of the patient with the rationale that such testing will result in the rapid generation of results and improve patient care. POCT is frequently undertaken by nonlaboratory personnel both within and outwith the hospital setting and the last 10 years has seen a significant increase in its use, particularly in the field of haemostasis. The importance of POCT is highlighted by a recent publication from the This review summarizes POCT in relation to haemostasis, and complements a previously published guideline by the British Committee for Standards in Haematology on POCT in Haematology (Briggs et al, 2008).

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“…If two different tests, such as EXTEM and FIBTEM, are run simultaneously, comparing the difference between clot firmness will represents the platelet contribution to clot formation. However, since conventional TEG/ROTEM are not sensitive to targeted pharmacological inhibition, a more refined test has been developed for the TEG to specifically determine platelet function in the presence of antiplatelet therapy (PlateletMapping TM ) [32,33]. The Platelet Mapping assay measures clot strength as maximal amplitude and enables for the quantification of platelet function, including the contribution of adenosine phosphate and thromboxane A2 receptors to clot formation.…”

Section: Monitoring Anticoagulationmentioning

confidence: 99%

Perioperative coagulopathy monitoring

et al. 2013

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Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), ''Point-ofcare'' coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.

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Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery

Cited by 50 publications

References 17 publications

Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Point‐of‐care testing in haemostasis

Perioperative coagulopathy monitoring

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Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery

Cited by 50 publications

References 17 publications

Platelet mapping as part of modified thromboelastography (TEG®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Platelet mapping as part of modified thromboelastography (TEG®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Point‐of‐care testing in haemostasis

Perioperative coagulopathy monitoring

Contact Info

Product

Resources

About

Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass

Platelet mapping as part of modified thromboelastography (TEG^®) in patients undergoing cardiac surgery and cardiopulmonary bypass