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Early platelet recovery following cardiac surgery with cardiopulmonary bypass
Sven Van Poucke1, Kris Stevens2, Rick Wetzels3
1a Department of Anaesthesiology , Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg (ZOL) , Genk , Belgium.
Insights
Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) causes temporary platelet dysfunction. Platelet function recovers within 24 hours post-surgery, with arachidonic acid-induced aggregation increasing, potentially guiding antiplatelet therapy.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Clinical Pathology
Background:
- Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) often leads to decreased platelet count and impaired platelet function (PF).
- Understanding the temporal dynamics of platelet dysfunction and recovery post-CPB is crucial for managing bleeding risks and graft patency.
- Current laboratory assessments for PF are complex and their time-related changes after CABG require further elucidation.
Purpose of the Study:
- To investigate the time-related changes in platelet function induced by CPB.
- To assess the recovery of platelet function within 24 hours after CABG.
- To evaluate the utility of different laboratory tests in detecting CPB-induced platelet dysfunction.
Main Methods:
- Prospective study involving 20 patients undergoing CABG with preoperative platelet counts >250 × 10^9/L.
- Blood samples collected pre-incision, post-CPB weaning, and 24 hours post-surgery.
- Platelet function assessed using multiple electrode impedance aggregometry (MEIA) and light transmission aggregometry (LTA) with various agonists (AA, ADP, collagen, TRAP).
- Platelet contribution to coagulation quantified by PLTEM using rotational thromboelastometry (ROTEM).
Main Results:
- Significant platelet dysfunction was observed immediately after CPB, with partial recovery noted within 24 hours.
- Arachidonic acid-induced platelet aggregation, measured by LTA, showed a significant increase 24 hours post-surgery compared to baseline.
- MEIA and ROTEM results correlated with platelet count and hematocrit, whereas LTA did not show such correlations.
- PLTEM maximum clot firmness remained stable throughout the study period.
Conclusions:
- CPB induces reversible platelet dysfunction that largely recovers within 24 hours post-CABG.
- The observed increase in AA-induced aggregation post-surgery may inform the timing of antiplatelet therapy initiation.
- MEIA serves as a valuable point-of-care test for detecting platelet dysfunction in cardiac surgery patients with platelet counts as low as 150 × 10^9/L.
Abstract:
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is frequently associated with low platelet count (PC) and disturbed platelet function (PF). While PC is easy to measure, PF is more difficult to assess. Moreover, the time-related platelet dysfunction and recovery after CPB is not fully elucidated. Platelet dysfunction could lead to bleeding but also to coronary graft failure. Laboratory tests could provide more insights into PF after CABG. The aim of the current study was to investigate the time-related PF induced by CPB. Blood samples of 20 patients with a preoperative PC of more than 250 × 109/L were collected before incision, after weaning from CPB, and 24 h postoperative. Platelet contribution to coagulation was quantified by PLTEM (calculated by means of EXTEM and FIBTEM results). PF was assessed by multiple electrode impedance aggregometry (MEIA) in whole blood and by light transmission aggregometry (LTA) in platelet-rich plasma after stimulation with arachidonic acid (AA), adenosine diphosphate, collagen, and thrombin-receptor-activating peptide. LTA and MEIA analysis demonstrated significant platelet dysfunction after CPB, with partial recovery within 24 h after surgery. AA-induced platelet aggregation increased to higher levels within 24 h after surgery compared to baseline values as measured by LTA. PLTEM maximum clot firmness remained unchanged throughout the study. Correlation analyses revealed that MEIA and rotational thromboelastometry (ROTEM), but not LTA, were dependent on PC and hematocrit. No correlations were found between LTA, MEIA, ROTEM, PC, and clinical outcome parameters. Our results demonstrate a reversible platelet dysfunction recovering within 24 h after CPB. Interestingly, AA-induced platelet aggregation increases to higher levels during the first 24 h postoperatively, which might be important for early initiation of antiplatelet therapy after CABG. MEIA as POC test is able to detect platelet dysfunction during cardiac surgery with a PC of ≥150 × 109/L.
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