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Thromboelastograph with Platelet Mapping(TM) predicts postoperative chest tube drainage in patients undergoing
Mohsin Chowdhury1, Linda Shore-Lesserson2, Alec M Mais3
1Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx.
Insights
Thromboelastograph with Platelet Mapping (TEG-PM) effectively predicts bleeding after coronary artery bypass grafting (CABG) in patients on antiplatelet therapy. Specific TEG-PM parameters and BMI indicate higher risks of chest tube drainage and transfusion needs.
Area of Science:
- Cardiology
- Anesthesiology
- Hematology
Background:
- Coronary artery bypass grafting (CABG) patients on antiplatelet therapy face bleeding risks.
- Predicting postoperative bleeding is crucial for patient management and resource allocation.
Purpose of the Study:
- To assess the predictive capability of Thromboelastograph with Platelet Mapping (TEG-PM) for postoperative bleeding in CABG patients with recent antiplatelet use.
- To identify specific TEG-PM parameters associated with elevated chest tube drainage (CTD) and blood transfusion requirements.
Main Methods:
- Retrospective analysis of 78 patients undergoing on-pump CABG with preoperative TEG-PM testing.
- Logistic regression was used to associate TEG-PM variables (MAADP, MAAA, platelet inhibition percentages) and BMI with outcomes (elevated CTD, blood transfusion).
- Elevated CTD was defined as ≥ 600 mL within 12 hours post-surgery.
Main Results:
- 25.6% of patients experienced elevated CTD.
- Decreased maximum amplitude produced by adenosine diphosphate (MAADP), increased clopidogrel inhibition, and lower body mass index (BMI) were significantly linked to elevated CTD.
- These factors also correlated with increased platelet transfusion needs.
Conclusions:
- TEG-PM parameters, specifically MAADP, and BMI are significant predictors of elevated CTD and platelet transfusion in CABG patients.
- A 1 mm decrease in MAADP increases the likelihood of elevated CTD and transfusion by 6%.
- A 1-unit decrease in BMI is associated with a 22-23% increased likelihood of elevated CTD and transfusion.
Objective:
The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PM(TM)) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG).
Design:
A retrospective analysis. Association between predictor variables (MAADP [maximum amplitude produced by adenosine diphosphate], MAAA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was ≥ 600 mL within 12 hours after surgery.
Setting:
A university hospital.
Participants:
Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PM(TM) done as a point-of-care test.
Interventions:
None.
Results:
A total of 78 patients had preoperative TEG-PM(TM) test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77).
Conclusions:
TEG-PM(TM) parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively.
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