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Does Preoperative Platelet Function Predict Bleeding in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?
Peter B Berger1,2, H Lester Kirchner3, Eric S Wagner2
1Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania.
Insights
Preoperative platelet function tests showed poor correlation with each other and with bleeding after coronary artery bypass grafting (CABG). Current assays may not reliably predict bleeding risk in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Clinical Diagnostics
Background:
- Platelet aggregability can be measured using various methods.
- Limited understanding exists regarding the correlation between different platelet function assays and their relationship with bleeding outcomes.
Purpose of the Study:
- To investigate the association between preoperative platelet function tests and perioperative bleeding in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Prospective study of 50 patients undergoing off-pump CABG.
- Preoperative platelet function assessed using VerifyNow®, TEG®, AggreGuide™, Plateletworks®, VASP phosphorylation, and light transmission aggregometry.
- Perioperative bleeding evaluated by hematocrit drop and chest tube drainage.
Main Results:
- Weak correlations were observed between most point-of-care platelet function tests and hematocrit changes.
- Plateletworks® showed a weak correlation with hematocrit drop (r=0.2882, P=0.0470).
- AggreGuide™ and VASP phosphorylation demonstrated weak correlations with chest tube drainage (r=-0.3073, P=0.0317 and r=-0.3187, P=0.0272, respectively).
- Correlations among the four point-of-care tests themselves were also poor.
Conclusions:
- Limited correlation exists among common platelet function tests and between these assays and perioperative bleeding.
- The utility of current platelet function assays in guiding clinical decisions for individual CABG patients remains uncertain.
Objective:
We sought to examine the relationship between preoperative platelet function and perioperative bleeding in patients undergoing CABG.
Background:
There are many ways to measure platelet aggregability. Little is known about their correlations with one another, or with bleeding.
Methods:
We prospectively studied 50 patients undergoing a first isolated off-pump CABG. Thirty-four were exposed to a thienopyridine prior to surgery; 16 were not. Preoperative platelet function was measured by VerifyNow®, TEG®, AggreGuide™, Plateletworks®, vasodilator-stimulated phosphoprotein (VASP) phosphorylation, and light transmission aggregometry. Bleeding was assessed 2 ways: drop from pre- to nadir postoperative hematocrit, and chest tube drainage. Correlation coefficients were calculated using Spearman's rank-order correlation.
Results:
Mean age was 62 years. Patient characteristics and surgical details were similar between the thienopyridine-exposed and non-exposed patients. The correlation coefficients between the 4 point-of-care platelet function measurements and hematocrit change ranged from -0.2274 to 0.2882. Only Plateletworks® correlated with drop in hematocrit (r = 0.2882, P = 0.0470). The correlation coefficients between each of the 4 point-of-care platelet function tests and the chest tube drainage were also poor, ranging from -0.3073 to 0.2272. Both AggreGuide™ (r = -0.3073, P = 0.0317) and VASP (r = -0.3187, P = 0.0272) were weakly but significantly correlated with chest tube drainage. The correlation among the 4 point-of-care platelet function measurements was poor, with coefficients ranging from -0.2504 to 0.1968.
Conclusions:
We observed little correlation among 4 platelet function tests, and between those assays and perioperative bleeding defined 2 different ways. Whether any of these assays should be used to guide decision making in individual patients is unclear.
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