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Updated: Oct 10, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet function assessed by ROTEM®platelet in patients receiving antiplatelet therapy during cardiac and vascular
Anna Schultz-Lebahn1, Peter H Nissen1,2, Troels Fogh Pedersen3
1Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Insights
Rotational thromboelastometry (ROTEM®) platelet analysis detects aspirin but often misses clopidogrel in patients undergoing surgery. The study could not confirm if reduced platelet function correlates with increased bleeding risk.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Patients undergoing coronary artery bypass graft (CABG) and carotid endarterectomy (CEA) often continue antiplatelet therapy perioperatively.
- Perioperative antiplatelet therapy can increase the risk of bleeding complications.
- Accurate assessment of platelet function is crucial for managing bleeding risk in these patients.
Purpose of the Study:
- To evaluate the ability of Rotational thromboelastometry (ROTEM®) platelet analysis to detect antiplatelet therapy (aspirin and clopidogrel) in CABG and CEA patients.
- To investigate the association between reduced platelet function detected by ROTEM® platelet and perioperative bleeding.
- To assess the effect of ex vivo desmopressin on platelet function in these patients.
Main Methods:
- Prospective study including 20 CABG patients on aspirin and 20 CEA patients on clopidogrel or dual antiplatelet therapy (aspirin and clopidogrel).
- Platelet function was assessed using ROTEM® platelet and light transmission aggregometry (LTA).
- Bleeding was quantified by chest tube output; bleeding risk was assessed using a published cut-off.
Main Results:
- ROTEM® platelet detected aspirin therapy based on the lower reference limit but showed inadequate detection of clopidogrel compared to LTA.
- 30% of aspirin users and 21% of dual therapy users had platelet function below the bleeding risk cut-off.
- Ex vivo desmopressin did not significantly improve platelet function.
- No significant difference in chest tube output was observed between CABG patients with platelet function above or below the bleeding risk cut-off.
Conclusions:
- ROTEM® platelet effectively identifies aspirin treatment but frequently overlooks clopidogrel therapy.
- The study population had low bleeding events, precluding a definitive conclusion on the association between ROTEM® platelet-detected platelet dysfunction and bleeding risk.
- Further research with larger cohorts is needed to validate ROTEM® platelet's clinical utility in managing antiplatelet therapy during major surgeries.
Abstract:
Patients undergoing coronary artery bypass graft (CABG) surgery or carotid endarterectomy (CEA) continue antiplatelet therapy perioperatively, which may increase bleeding risk. We aimed to investigate whether Rotational thromboelastometry (ROTEM®) platelet, a newly marketed platelet function analysis, would detect antiplatelet therapy in CABG and CEA patients; whether detection of reduced platelet function was associated with increased bleeding; and whether ex vivo desmopressin increased platelet function. We included 20 CABG patients continuing aspirin and 20 CEA patients continuing clopidogrel (n = 1) or clopidogrel and aspirin (n = 19). Platelet function was analyzed with ROTEM®platelet and light transmission aggregometry (LTA). According to the lower reference limit, ROTEM®platelet managed to detect aspirin, but clopidogrel detection was inadequate compared to LTA. Using a previously published cut-off for bleeding risk, 6 (30%) patients receiving aspirin and 4 (21%) patients receiving both clopidogrel and aspirin demonstrated platelet function below this cut-off. One of the four CEA patients below the cut-off died from intracerebral hemorrhage postoperatively. CABG patients below (n = 6) and above (n = 14) the cut-off did not differ in chest tube output (median [range]: 373 ml [250-900] vs. 368 ml [195-820]). Ex vivo addition of desmopressin did not increase platelet function. In conclusion, ROTEM®platelet does reveal aspirin treatment whereas clopidogrel treatment is most often overlooked. Due to low bleeding in the study population, it was not possible to conclude on the association with bleeding risk.
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