Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study

Ranucci, Marco; Pistuddi, Valeria; Dedda, Umberto Di; Menicanti, Lorenzo; Vincentiis, Carlo De; Baryshnikova, Ekaterina

doi:10.1080/09537104.2018.1535706

Cited by 42 publications

(41 citation statements)

References 18 publications

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“…Moreover, unpublished data from our registry show preservation of ADP receptors combined with improved function of PAR receptors related to preoperative values. This comes in overt contrast with the existing literature, which recommends the deterioration in platelet function as a rule in cardiac surgery when using conventional CPB (26). However, we support the notion proposed by Di Dedda et al who assert that the preserved platelet function reflects a well-functioning microcirculation, which is probably the rationale behind the protective effect of MiECC on platelets (27).…”

Section: The Value Of Poc Coagulation Management During Surgery With supporting

confidence: 66%

Point-of-care coagulation management during surgery with minimal invasive extracorporeal circulation

et al. 2019

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Section: The Value Of Poc Coagulation Management During Surgery With supporting

confidence: 66%

Point-of-care coagulation management during surgery with minimal invasive extracorporeal circulation

et al. 2019

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“…The present study is a post-hoc analysis of three previous (two retrospective in 2012–2013 and one prospective in 2016–2017) studies performed at our institution between 2010 and 2017 [18–20]. In these studies, patients scheduled for cardiac operations were investigated with standard laboratory tests and POC PFT before surgery.…”

Section: Methodsmentioning

confidence: 99%

Gender-based differences in platelet function and platelet reactivity to P2Y12 inhibitors

et al. 2019

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BackgroundGender influences platelet biology. Women have a larger platelet count, but gender-based differences in platelet function remain debated. We performed a study addressing gender-based differences in platelet function using point-of-care platelet function tests (PFT).MethodsThe patient population consisted of 760 cardiac surgery patients where preoperative PFT (multiple-electrode aggregometry [MEA]) were available. Platelet count and function at the ADPtest and TRAPtest were compared in the overall population and separately in patients with or without residual effects of P2Y12 inhibitors.ResultsWomen had a significantly (P = 0.001) higher platelet count but a non-significantly higher platelet reactivity to ADP. In clopidogrel-treated patients, the platelets ADP reactivity was significantly (P = 0.031) higher in women, and platelet count was the main determinant of platelet hyper-reactivity. Within patients under full clopidogrel effects, women with a platelet count ≥ 200,000 cells/μL had a significantly (P = 0.023) higher rate of high-on-treatment platelet reactivity (HTPR, 45.5%) with respect to males with a platelet count < 200,000 cells/μL (11.9%), with a relative risk of 6.2 (95% confidence interval 1.4–29).ConclusionsOur findings confirm that women have a larger platelet count than men, and that this is associated to a trend towards a higher platelet reactivity. HTPR is largely represented in women with a high platelet count. This generates the hypothesis that women requiring P2Y12 inhibitors could potentially benefit from larger doses of drug or should be treated with anti-platelet agents with a low rate of HTPR.

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“…The sample size was settled based on an expected reduction in ADPtest value not exceeding 20%. 7 Thus, considering a 90% statistical power and 5% significance level, a sample size of at least 54 patients was calculated. Study was approved by local Institutional Review Board (identification number: 49886/8.11.2018), and all patients gave written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

et al. 2019

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Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

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Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study

Cited by 42 publications

References 18 publications

Point-of-care coagulation management during surgery with minimal invasive extracorporeal circulation

Point-of-care coagulation management during surgery with minimal invasive extracorporeal circulation

Gender-based differences in platelet function and platelet reactivity to P2Y12 inhibitors

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

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