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Use of thrombin generation test for monitoring hemostasis in coronary bypass surgery
Olga Gruzdeva1, Evgenya Uchasova1, Elena Fanaskova1
1Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russia.
Insights
For coronary artery disease patients undergoing bypass surgery, prolonged aspirin therapy did not necessitate donor platelet transfusions. Thrombin generation tests showed preserved hemostatic potential, indicating transfusions are likely unnecessary.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Surgical Research
Background:
- Patients with coronary artery disease (CAD) often undergo coronary artery bypass grafting (CABG).
- Prolonged aspirin therapy is common in CAD patients, potentially affecting hemostasis during surgery.
- The necessity of platelet transfusions in these patients remains a clinical question.
Purpose of the Study:
- To evaluate thrombin generation test (TGT) parameters in CAD patients on aspirin therapy during on-pump CABG.
- To determine the impact of donor platelet concentrate transfusion on hemostasis in this patient cohort.
Main Methods:
- A total of 148 CAD patients on aspirin therapy undergoing on-pump CABG were enrolled.
- Patients were randomized into two groups: one receiving donor platelet transfusion post-cardiopulmonary bypass, the other not.
- Thrombin generation test (TGT) parameters were assessed preoperatively, intraoperatively, and postoperatively.
Main Results:
- Patients on aspirin therapy exhibited activated endogenous thrombin potential pre- and intraoperatively, with high peak thrombin and increased velocity index.
- Activation time and thrombin generation time were prolonged compared to controls.
- Patients not receiving transfusions showed decreased postoperative hemostatic potential, normalizing over time.
- Plasma hemostatic potential was preserved in aspirin-treated patients.
Conclusions:
- Platelet concentrate transfusion appears unnecessary for preventing hemostatic issues in CAD patients on prolonged aspirin therapy undergoing on-pump CABG.
- Thrombin generation testing provides insights into the hemostatic status of these patients.
- Clinical decisions regarding platelet transfusions should consider laboratory findings and patient-specific factors.
Abstract:
To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75-100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.
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