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Usefulness of monitoring platelet function by multiple electrode aggregometry in primary coronary artery bypass
Andinet M Mengistu1, Jochen Mayer, Joachim Boldt
1Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany. a.mengistu@gmx.de
Insights
Multiple-electrode aggregometry (MEA) effectively monitors platelet inhibition from aspirin (ASA) and clopidogrel. Preoperative ADP-MEA identifies patients at higher risk for blood transfusions after coronary artery bypass graft (CABG) surgery.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Antiplatelet therapy, including aspirin (ASA) and clopidogrel, is crucial for preventing cardiovascular complications.
- However, this therapy increases the risk of perioperative bleeding, particularly in patients undergoing coronary artery bypass graft (CABG) surgery.
- Monitoring platelet inhibition is essential for managing bleeding risks.
Purpose of the Study:
- To investigate the utility of multiple-electrode aggregometry (MEA) for monitoring platelet inhibition by ASA and clopidogrel.
- To assess the correlation between MEA measurements and clinical outcomes, specifically postoperative blood loss and transfusion requirements in CABG patients.
Main Methods:
- A prospective observational study was conducted involving 150 patients scheduled for elective CABG surgery.
- Patients were divided into three groups: no antiplatelet therapy, ASA only, and combined ASA and clopidogrel therapy.
- Preoperative MEA was performed using collagen (COL-MEA) or adenosine diphosphate (ADP-MEA). Postoperative blood loss and transfusion needs were recorded over 24 hours.
Main Results:
- Postoperative blood loss significantly increased in patients receiving combined ASA and clopidogrel therapy.
- MEA results, particularly ADP-MEA, correlated with postoperative blood loss.
- Both COL-MEA and ADP-MEA effectively distinguished between patients on ASA and clopidogrel, with high sensitivity and specificity.
- ADP-MEA identified an increased risk of postoperative transfusion in patients treated with clopidogrel (odds ratio = 2.92).
Conclusions:
- Multiple-electrode aggregometry (MEA) is a suitable method for detecting platelet inhibition by aspirin and clopidogrel in CABG patients.
- Preoperative ADP-MEA appears to be a valuable tool for identifying patients at risk of requiring postoperative transfusions.
Objectives:
Antiplatelet therapy commonly is used for the prevention of cardiovascular complications but increases the risk of perioperative bleeding. Multiple-electrode aggregometry (MEA) was investigated for monitoring platelet inhibition by acetylsalicylic acid (ASA) and clopidogrel in patients undergoing elective coronary artery bypass graft (CABG) surgery with regard to clinical outcome as measured by postoperative blood loss and transfusion requirements.
Design:
A prospective observational study.
Setting:
A teaching hospital.
Participants:
One hundred fifty patients scheduled for elective CABG surgery were included: without antiplatelet therapy (group A, n = 50), single ASA exposure (group B, n = 50), and combined therapy with ASA and clopidogrel (group C, n = 50).
Measurements And Main Results:
MEA was assessed preoperatively using either collagen (COL-MEA) or ADP (ADP-MEA). Postoperative blood loss and transfusion requirements were recorded for 24 hours after surgery. Postoperative blood loss significantly increased only from combined antiplatelet therapy (group A: 572 ± 297 mL, group B: 721 ± 356 mL, group C: 865 ± 346, p < 0.01) and correlated with ADP (r(p) = -0.35, p < 0.01) and COL-MEA (r(p) = -0.23, p > 0.01). COL-MEA and ADP-MEA discriminated between preoperative ASA and clopidogrel intake (ASA: sensitivity = 86.3%, and specificity = 89.3%; clopidogrel: sensitivity = 87.5%, and specificity = 95.1%). The postoperative transfusion risk was increased in patients diagnosed for clopidogrel treatment by ADP-MEA (odds ratio = 2.92; confidence interval: 1.44-5.92; p = 0.005).
Conclusions:
MEA is a suitable method for the detection of platelet inhibition by ASA and clopidogrel in patients undergoing CABG surgery. In these patients, preoperative ADP MEA seems to indicate patients at risk for postoperative transfusion requirements.
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