Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry

Rahe‐Meyer, Niels; Winterhalter, Michael; Boden, A. G.; Froemke, C.; Piepenbrock, S.; Calatzis, Andreas; Solomon, Cristina

doi:10.1111/j.1399-6576.2008.01845.x

Cited by 130 publications

(116 citation statements)

References 24 publications

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“…This is consistent with several previous studies in which demographic details, comorbidities, conventional pre‐operative laboratory test results31, 32, 33, 34, 35, and procedural characteristics31, 35 contributed to prediction of RBC transfusion. The baseline‐only model confirmed that exposure to anti‐platelet drugs before cardiac surgery is also a strong predictor of post‐operative bleeding 17, 20. We also showed that for patients having CABG, aspirin plus a P2Y 12 blocker stopped for less than 2 days increased the risk of severe bleeding fourfold compared to aspirin alone.…”

Section: Discussionsupporting

confidence: 69%

“…Previous studies have also shown that some near‐patient test results from before the start, or immediately after the end of cardiac surgery also enable prediction of postoperative bleeding 17, 18, 19, 20, 21, 22, 23. This suggests an alternative blood management strategy in which near‐patient testing is performed pre‐emptively before the highest risk period for severe bleeding in the immediate post‐operative period.…”

Section: Introductionmentioning

confidence: 93%

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Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 93%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…The surgery was successful, clopidogrel and aspirin were restarted eight hours later with loading doses, and the patient did not experience any thrombotic or bleeding events during the perioperative period [19]. Small studies have shown that adenosine diphosphate aggregometry, multiple electrode platelet aggregometry, and thromboelastography platelet mapping may be able to predict bleeding risks for patients receiving coronary artery bypass grafts (CABG) [20][21][22]. However, one of those studies showed that the point-of-care tests Platelet Function Analyzer 100 and Platelet Works were not predictive of which patients receiving CABG would bleed [20].…”

Section: Discussionmentioning

confidence: 99%

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Lalama¹

2011

J Clinic Experiment Cardiol

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Purpose: To describe how VerifyNow P2Y 12 testing for clopidogrel response is being utilized at a community hospital.Methods: A retrospective chart review was conducted at a 411-bed community hospital in patients who tested positive for poor clopidogrel response.Results: There were 95 positive P2Y 12 tests evaluated in this study. Positive P2Y 12 tests were obtained 40.0% of the time for cardiovascular indications, 28.4% for neurologic indications, 1.1% for hematologic indications, and 30.5% were obtained to evaluate patients prior to surgery. The medication regimens of 38.8% of patients did not change as a result of a positive test for poor clopidogrel response. The clopidogrel dose was increased in 16.3% of patients, and clopidogrel was discontinued in 10.2% of patients positive for poor clopidogrel response not undergoing surgical evaluation. Rehospitalization rates of non-surgical patients for recurrent thrombosis or bleeding at 90 days were highest for patients who had an additional antiplatelet agent or anticoagulant added due to poor clopidogrel response. The lowest rehospitalization rate was seen in patients switched to an alternative agent. Conclusions:The most common findings after a positive P2Y 12 test in non-surgical patients were no change in therapy and increasing the dose of clopidogrel. Adding an additional antiplatelet agent or anticoagulant was associated with the highest risk of rehospitalization.

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“…Preoperative strong antiplatelet-drug-induced inhibition is an important contributory factor that is correlated with increased postoperative bleeding and platelet transfusion requirement [2,[25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy before cardiac surgery

Demertzis¹,

Cassina²,

Casso³

2016

Cardiovasc Med

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Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry

Cited by 130 publications

References 24 publications

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Antiplatelet therapy before cardiac surgery

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