Bleeding risk assessment in patients undergoing elective cardiac surgery using ROTEM(®) platelet and Multiplate(®)...

Area of Science:

• Cardiovascular Medicine
• Hematology
• Surgical Research

Background:

• Impaired platelet function is a significant risk factor for peri-operative bleeding and the need for blood transfusions.
• Cardiac surgery involving cardiopulmonary bypass frequently leads to altered platelet function.

Purpose of the Study:

• To evaluate the efficacy of two whole blood impedance aggregometers in assessing peri-operative platelet function.
• To correlate platelet function measurements with postoperative bleeding and transfusion requirements in patients undergoing elective cardiac surgery.

Main Methods:

• Prospective observational study of 101 patients undergoing elective cardiac surgery with cardiopulmonary bypass.
• Platelet function assessed using ROTEM® platelet and Multiplate® aggregometers with arachidonic acid, adenosine diphosphate, and thrombin receptor-activating peptide-6 activators.
• Measurements taken at three peri-operative time points: pre-anesthesia, post-aortic declamping, and post-protamine administration.

Main Results:

• Platelet function was consistently impaired throughout the peri-operative period across all assays.
• Measurements taken after protamine administration showed the strongest correlation with postoperative chest tube drainage.
• Both devices demonstrated comparable predictability for postoperative chest tube drainage and red blood cell transfusion needs.

Conclusions:

• Peri-operative platelet function monitoring using impedance aggregometry can predict bleeding and transfusion risks in cardiac surgery patients.
• The degree of platelet inhibition and the number of inhibited pathways are associated with transfusion requirements.
• Both ROTEM® platelet and Multiplate® are valuable tools for assessing platelet function and guiding transfusion strategies in this patient population.