Related Experiment Video
Updated: Nov 22, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational
Milos Matkovic1,2, Tina Novakovic3, Ilija Bilbija1,2
1Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.
Insights
Preoperative platelet function tests, including adenosine di-phosphate high sensitive (ADPHS) and arachidonic acid (ASPI) tests, can predict bleeding in coronary artery bypass grafting (CABG) patients. Adjusting test cut-off values improves their utility for guiding transfusions.
Area of Science:
- Cardiology
- Hematology
- Surgical Innovation
Background:
- Preoperative platelet function tests reduce re-intervention rates and transfusion needs in coronary artery bypass grafting (CABG).
- Multiple electrode aggregometry (MEA) is a key tool for assessing platelet function.
- The predictive value of MEA for routine use in CABG patients requires further investigation.
Purpose of the Study:
- To evaluate the predictive capability of MEA for bleeding events in CABG patients.
- To determine if routine preoperative MEA is justified in elective CABG.
- To assess the impact of MEA results on transfusion requirements.
Main Methods:
- A prospective observational study included 416 patients undergoing elective isolated CABG.
- Platelet function was assessed using the Multiplate® test, specifically the arachidonic acid (ASPI) and adenosine di-phosphate high sensitive (ADPHS) assays.
- Receiver operating characteristic (ROC) analysis was used to determine test sensitivity and specificity for predicting blood loss and transfusion needs.
Main Results:
- Both ADPHS and ASPI tests significantly predicted excessive bleeding (>1000 ml).
- Optimized cut-off values for ADPHS and ASPI demonstrated moderate sensitivity and specificity in predicting bleeding.
- Patients with ADPHS results below specific thresholds received more platelet and cryoprecipitate transfusions, indicating a link between impaired platelet function and transfusion requirements.
Conclusions:
- Systematic preoperative platelet function testing is recommended for all elective CABG patients on dual antiplatelet therapy.
- Adjusting test cut-off values for specific patient populations is crucial for maximizing the clinical utility of these tests.
- Routine use of MEA can aid in optimizing transfusion strategies and potentially reduce complications.
Background:
Preoperative use of platelet function tests contributes to the decrease of re-intervention rate due to bleeding and the necessity of transfusion in coronary artery bypass grafting (CABG) patients. The aim was to investigate the predictive value and to justify routine preoperative use of multiple electrode aggregometry in these patients.
Methods:
A prospective observational trial which included 416 consecutive patients subjected to elective isolated CABG was conducted. The Multiplate® test was used to assess platelet function. Platelet function test results, postoperative blood loss, and transfusion requirements were compared between high and low bleeding risk patients. Receiver operating characteristic analysis was performed to assess the sensitivity and specificity of the arachidonic acid (ASPI) and adenosine di-phosphate high sensitive (ADPHS) tests.
Results:
ADPHS and ASPI test results significantly predicted total bleeding > 1000 ml (AUC, 0.685, p < .001; 0.695, p = .039). Sensitivity and specificity were 62.9% and 40.0%, for ADPHS ≤602, and 70.8% and 41.8%, for ASPI ≤ 453. The sensitivity and specificity of cut-off values recommended by the manufacturer were 84.2% and 40.0% for ADPHS ≤ 500, while for ASPI < 600 the values were 54.7% and 62.2%. More platelets and cryoprecipitate were transfused in patients with ADPHS ≤ 602.5 (p < .001; p = .035). Patients with ADPHS ≤ 500 had a higher rate of red blood count, platelet and cryoprecipitate transfusion (p<.001p<.001; p = .013). The manufacturer's ASPI test cut-off values showed no statistically significant prediction for a higher transfusion rate.
Conclusion:
Preoperative platelet function tests should be conducted systematically for all elective CABG patients who were on dual antiplatelet therapy after adjusting test cut-off values for each population.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care