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Reversible shear-mediated platelet dysfunction during cardiac surgery as assessed by the PFA-100 platelet function
T F Slaughter1, G Sreeram, A D Sharma
1Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. slaug003@mc.duke.edu
Summary
Cardiac surgery impairs platelet function, affecting bleeding risk. The PFA-100 test shows potential for identifying patients unlikely to benefit from platelet transfusions post-surgery.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Platelet Physiology
Background:
- Cardiac surgery involves cardiopulmonary bypass (CPB), which can affect platelet function.
- Assessing shear-mediated platelet dysfunction is crucial for managing post-operative bleeding.
Purpose of the Study:
- To evaluate changes in shear-mediated platelet function during cardiac surgery.
- To determine if the PFA-100 assay can predict post-operative bleeding.
Main Methods:
- Platelet aggregation and PFA-100 closure times were measured in patients during cardiac surgery.
- Associations between PFA-100 closure times and post-operative bleeding were analyzed.
Main Results:
- Collagen/epinephrine closure times were prolonged throughout surgery.
- Collagen/adenosine-5'-diphosphate (ADP) closure times significantly increased with heparin and CPB, returning to baseline after protamine.
- Platelet aggregation in response to ADP remained impaired post-CPB in most patients.
Conclusions:
- Both intrinsic and extrinsic factors contribute to reversible platelet dysfunction during CPB.
- The PFA-100 assay may help identify patients who will not benefit from platelet transfusions after CPB.