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Perioperative changes in platelet count and function in patients undergoing cardiac surgery
Elham Khalaf Adeli1, Seyed Mostafa Alavi2, Alireza Alizadeh-Ghavidel3
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Insights
Cardiac surgery impairs platelet function and count, increasing bleeding risk. Monitoring platelet dysfunction perioperatively can guide bleeding management strategies.
Area of Science:
- Cardiology
- Hematology
- Surgical Science
Background:
- Patients undergoing cardiac surgery face elevated bleeding risks due to complex coagulopathies.
- Multifactorial coagulopathies contribute to increased bleeding complications in cardiac surgery patients.
Purpose of the Study:
- To investigate alterations in platelet count and function during and after cardiac surgery.
- To determine the association between platelet dysfunction and postoperative bleeding and transfusion needs.
Main Methods:
- Prospective observational study of 40 adult patients undergoing elective valve coronary cardiac surgery.
- Analysis of platelet count and function (ADP, arachidonic acid, collagen-induced aggregation) at pre-CPB, post-CPB, and 24-hour post-surgery time points.
- Recording of postoperative bleeding and intraoperative transfusion requirements.
Main Results:
- Platelet count and aggregation significantly decreased during cardiopulmonary bypass (CPB).
- Platelet count reduced by approximately 40% post-CPB, persisting postoperatively.
- Abnormal ADP-induced platelet aggregation correlated with increased postoperative bleeding and transfusion requirements.
Conclusions:
- CPB significantly reduces platelet count and aggregation, contributing to postoperative bleeding.
- Platelet dysfunction is a key factor in increased bleeding and transfusion needs after cardiac surgery.
- Perioperative platelet function monitoring may enhance bleeding management and support the implementation of patient blood management (PBM) programs.
Abstract:
Background: Patients undergoing cardiac surgery are at increased risk of bleeding due to multifactorial coagulopathies. In the present study, we aimed at investigating the changes in platelet count and function during and after surgery as well as determining the association of the platelet dysfunction with bleeding and transfusion requirements in these patients. Methods: A total of 40 adult patients scheduled for elective valve coronary cardiac surgery were included in this prospective observational study. Changes in platelet count and function with ADP, acid arachidonic, and collagen (light transmission aggregometry) were analyzed at three time points: before CPB, after CPB, and 24 hours after end of surgery. Postoperative bleeding and intraoperative transfusion requirements were recorded. Results: There were a significant reverse correlation between CPB time and ADP-induced aggregation, particularly after CPB and postoperative AA-induced aggregation. There was not any significant correlation between platelet count and function at all-time points. Both platelet count and platelet aggregation significantly reduced during CPB. While platelet aggregation increased on postoperative Day 1, platelet count reduced by about 40% after CPB, and remained at this level postoperatively. Patients with abnormal ADP-induced aggregation had significant increased postoperative bleeding and transfusion requirements. Conclusion: The results of this study demonstrate that platelet count and platelet aggregation are reduced during CPB. Our results emphasized the effect of platelet dysfunction on increased postoperative bleeding and transfusion requirements. Perioperative monitoring of platelet function can be considered as a bleeding management strategy for implantation of PBM programs.
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