The combined effects of the microcirculatory status and cardiopulmonary bypass on platelet count and function during cardiac surgery

Dedda, Umberto Di; Ranucci, Marco; Porta, Alberto; Bari, Vlasta; Ascari, Alice; Fantinato, Angela; Baryshnikova, Ekaterina; Cotza, Mauro

doi:10.3233/ch-180391

Cited by 15 publications

(17 citation statements)

References 32 publications

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“…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: 67%

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: 67%

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

et al. 2019

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“…MiECC attenuates systemic inflammatory response and preserves the integrity of microcirculation, as compared to cCPB; 13 moreover, it enhances recovery of microcirculatory blood flow, leading to faster restoration of nutritive microvascular blood flow. 14 According to the recent findings of Di Dedda et al, 15 disturbance of microcirculation integrity exerts a detrimental effect on platelet count and function. More specifically, chemical, such as pro-inflammatory and pro-coagulant factors, as well as mechanical (shear stress), factors lead to platelet activation, adhesion and aggregation.…”

Section: Discussionmentioning

confidence: 97%

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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“…To our knowledge, this relationship has not been previously reported. This association may be due to increased rates of microthrombi formation, reflected by thrombocytopenia, causing microvascular flow abnormalities ( 25 ). Thrombocytopenia may also reflect severe endothelial injury leading to platelet consumption ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…Thrombocytopenia may mediate poor patient outcomes via multiple mechanisms. For example, platelets may contribute directly to organ failure through microvascular dysfunction caused by activated platelet aggregation ( 25 ) or in response to endothelial damage ( 26 ). Data also suggest that platelets play an important role in host immune responses by mediating recruitment and translocation of mononuclear cells and lymphocytes into areas of inflammation ( 27,28 ).…”

mentioning

confidence: 99%

Effects of Baseline Thrombocytopenia and Platelet Decrease Following Renal Replacement Therapy Initiation in Patients With Severe Acute Kidney Injury*

Griffin

Jovanovich

You

et al. 2019

Critical Care Medicine

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Objectives: Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases. Design: Post hoc analysis of the Acute Renal Failure Trial Network Study. Setting: The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers. Subjects: The Acute Renal Failure Trial Network study evaluated 1,124 patients with severe acute kidney injury requiring renal replacement therapy. Interventions: Predictor variables were thrombocytopenia at initiation of renal replacement therapy and platelet decrease following renal replacement therapy initiation. Measurements and Main Results: Outcomes were mortality at 28 days, 60 days, and 1 year, renal recovery, renal replacement therapy free days, ICU-free days, and hospital-free days. Baseline thrombocytopenia in patients requiring renal replacement therapy was associated with increased mortality and was also associated with lower rates of renal recovery. A decrease in platelet values following renal replacement therapy initiation was associated with increased mortality. Continuous renal replacement therapy was not an independent predictor of worsening thrombocytopenia compared with those treated with intermittent hemodialysis.

show abstract

The combined effects of the microcirculatory status and cardiopulmonary bypass on platelet count and function during cardiac surgery

Abstract: A preoperative disturbance of the microcirculation is associated with a greater postoperative platelet dysfunction. Endothelial damage, chemical and mechanical stimuli are the possible link between the two patterns.

Cited by 15 publications

References 32 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

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

Effects of Baseline Thrombocytopenia and Platelet Decrease Following Renal Replacement Therapy Initiation in Patients With Severe Acute Kidney Injury*

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