Near-patient platelet function testing in patients undergoing coronary artery surgery: a pilot study

Area of Science:

• Cardiovascular Surgery
• Hematology
• Point-of-Care Testing

Background:

• Cardiopulmonary bypass (CPB) can lead to platelet dysfunction, increasing bleeding risk and the need for transfusions or resternotomy.
• Current platelet function tests lack standardization, reproducibility, and rapid availability, hindering timely clinical decisions.

Purpose of the Study:

• To evaluate the utility of multiple electrode platelet aggregometry (multiplate) for assessing platelet function in patients undergoing coronary artery surgery.
• To compare platelet function between patients who received blood transfusions and those who did not during CPB.

Main Methods:

• Studied 44 patients undergoing routine coronary artery surgery.
• Measured platelet aggregation using multiplate and light transmission aggregometry.
• Compared platelet function at baseline, during/after CPB, and during chest closure.

Main Results:

• Multiplate showed reduced platelet aggregation during and after CPB compared to baseline, with partial recovery upon transfer to the intensive care unit (ITU).
• Patients receiving blood transfusions exhibited significantly reduced platelet aggregation during chest closure (ADP: 18 U vs 29 U, p=0.01; TRAP-6: 65 U vs 88 U, p=0.01) compared to non-transfused patients.
• Multiplate analysis demonstrated sensitivity in detecting platelet dysfunction in the CPB setting.

Conclusions:

• Multiple electrode platelet aggregometry (multiplate) is a viable point-of-care tool for detecting platelet dysfunction following cardiopulmonary bypass.
• Blood transfusion during CPB is associated with exacerbated platelet dysfunction, detectable by multiplate.
• This suggests multiplate can aid in managing bleeding complications in cardiac surgery patients.