Heparin-induced platelet dysfunction and cardiopulmonary bypass

Muriithi, Elijah W.; Belcher, Philip R.; Day, Stephen P.; Menys, Valentine C.; Wheatley, David J.

doi:10.1016/s0003-4975(00)01299-6

Cited by 55 publications

(43 citation statements)

References 23 publications

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“…47 Muriithi et al found that a delayed heparin-induced impairment of platelet aggregation occurs in patients prior to CPB, which may suggest that platelet defects previously thought to be solely the result of passage through the bypass circuit may result from interaction with heparin. 48 Although Muriithi's study did not investigate PMV, their formation occurs simultaneously with platelet activation and therefore heparinisation may result in decreased PMV numbers.…”

Section: Anticoagulantsmentioning

confidence: 99%

Platelet Microvesicles (Microparticles) in Cardiac Surgery

Tempo

Englyst

Holloway

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Anticoagulantsmentioning

confidence: 99%

Platelet Microvesicles (Microparticles) in Cardiac Surgery

Tempo

Englyst

Holloway

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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“…The role of platelets in coagulation is complex, and involves adhesion, activation, aggregation and clot stabilisation. Platelet dysfunction is a recognised side effect of cardiopulmonary bypass (CPB) and plays a significant role in peri-operative blood product transfusion rates [5,6,[8][9][10][11].Standard thromboelastography (TEG Ò ; Haemonetics, Braintree, MA, USA) is a point of care test that measures the rate and strength of clot formation induced by thrombin, which is used as the main platelet activator [12]. Using TEG in a point of care-guided algorithm for management of post-CPB bleeding has been shown to decrease transfusion rates in complex cardiac surgery [4].…”

mentioning

confidence: 99%

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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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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“…According to available studies, the recorded decrease in platelet aggregability early after surgery was affected not only by the extracorporeal circulation (in on-pump group), but also, and possibly much more, by the effect of heparin [7]. The subsequent increase on day 2 was rather surprising, since we had expected that either the aggregability would not change or it would decrease after administration of another dose of aspirin.…”

Section: Discussionmentioning

confidence: 94%