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Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study

Marco Ranucci1, Valeria Pistuddi1, Umberto Di Dedda1

  • 1Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato , Milan , Italy.

Platelets
|October 27, 2018
PubMed

Insights

Platelet dysfunction after cardiac surgery significantly impacts bleeding risk. The Platelet Function in the Operating Room (PLATFORM) study found post-bypass platelet function tests, particularly ADPtest, predict severe bleeding, aiding clinical decisions.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Anesthesiology

Background:

  • Platelet dysfunction is a key factor in postoperative bleeding following cardiac surgery.
  • Current guidelines lack specific platelet activity cut-off values for managing bleeding patients.
  • Predicting severe bleeding risk requires better understanding of platelet function post-bypass.

Purpose of the Study:

  • To determine the relationship between platelet function after cardiopulmonary bypass and severe postoperative bleeding.
  • To identify predictive values of platelet function tests for severe bleeding.
  • To establish cut-off values for platelet activity to guide clinical interventions.

Main Methods:

  • Prospective cohort study (PLATFORM) involving 490 adult patients undergoing cardiac surgery with cardiopulmonary bypass.
  • Platelet function tests (ADPtest, TRAPtest) and routine coagulation tests were performed pre- and post-bypass.
  • Multivariable analysis was used to assess the association between platelet function and severe bleeding.

Main Results:

  • Post-bypass ADPtest and TRAPtest were significantly associated with severe bleeding (P=0.001).
  • ADPtest (OR 0.962) and activated partial thromboplastin time (OR 1.097) were independently associated with severe bleeding.
  • The post-bypass ADPtest showed the best discrimination (AUC 0.712), with a positive predictive value of 42% at a cut-off ≤8 U.

Conclusions:

  • Platelet function tests after cardiopulmonary bypass are significantly linked to postoperative bleeding.
  • While informative, platelet function alone does not offer a high positive predictive value for severe bleeding.
  • Postoperative bleeding is multifactorial, necessitating a comprehensive assessment beyond platelet function.

Keywords:
Bleedingcardiacplatelet function testssurgery

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