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Published on: June 4, 2020
Platelet function testing in cardiac surgery: A comparative study of electrical impedance aggregometry and
Bilal H Kirmani1, Robert Ian Johnson2, Seema Agarwal3
1a Departments of Perfusion , Liverpool Heart and Chest Hospital , Thomas Drive, Liverpool , UK.
Insights
The TEG® 6 PlateletMapping and Multiplate™ MEA show potential agreement in assessing platelet function before cardiac surgery, despite initial correlation issues. Further analysis suggests clinical utility for these point-of-care tests.
Area of Science:
- Cardiovascular Medicine
- Clinical Pathology
- Biomedical Engineering
Background:
- Point-of-care platelet function tests are crucial for managing antiplatelet therapy in cardiac surgery patients.
- Existing devices like Thromboelastography (TEG®) and Multiple Electrode Aggregometry (MEA) are widely used.
- The new TEG® 6 system with a PlateletMapping cartridge requires performance evaluation.
Purpose of the Study:
- To compare the performance of the TEG® 6 PlateletMapping system with the Multiplate™ MEA.
- To evaluate the agreement between these two point-of-care platelet function tests in cardiac surgery patients.
Main Methods:
- A comparative study involving 50 cardiac surgery patients.
- Preoperative platelet function testing using TEG® 6 PlateletMapping and Multiplate™ MEA.
- Tests were conducted with arachidonic acid (aspirin effect) and ADP (ADP antagonist effect).
- Analysis included Pearson's correlation and Bland-Altman plots.
Main Results:
- Pearson's correlation showed no significant correlation between MEA AUC and TEG® MA or % inhibition for either reagent.
- Bland-Altman analysis suggested potential agreement between the two methods, considering their different measurement scales.
- Both arachidonic acid and ADP tests were performed to assess different drug effects.
Conclusions:
- While direct correlation was not found, Bland-Altman plots indicate potential agreement between TEG® 6 PlateletMapping and Multiplate™ MEA.
- These point-of-care tests may offer complementary information for assessing drug-related platelet inhibition in cardiac surgery.
- Further research is warranted to fully understand the clinical utility and agreement of these assays.
Abstract:
Point of care platelet function tests are increasingly used to assess drug-related platelet inhibition prior to cardiac surgery. Numerous devices are available including Thromboelastography (TEG® PlateletMapping™). The latest generation TEG® - the TEG® 6 - has recently been released incorporating a cartridge-based system with a PlateletMapping cartridge. In this study, the performance of the TEG® 6 PlateletMapping was compared to that of Multiple Electrode Aggregometry (MEA) performed with the Multiplate™. Preoperative platelet function tests were performed on 50 cardiac surgery patients. Two sets of tests were performed using arachidonic acid and ADP assessing for aspirin and ADP antagonists, respectively, assessing the MEA area under the curve (AUC) in comparison to the TEG® maximal amplitude (MA) and percentage inhibition. For both arachidonic acid and ADP, the MEA AUC did not correlate with either the TEG® MA or % inhibition by Pearson's correlation. The Bland-Altman plots, however, indicated that there might be good agreement between the tests with either reagents, accounting for the different scales of measurement.
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