Perioperative Changes in Hemostatic Properties as Assessed by Multiplate, Siemens PFA-200, and ROTEM-A Comparative...

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Hematology

Background:

• Coronary artery bypass graft (CABG) surgery involves significant bleeding risks.
• Accurate assessment of hemostatic function is crucial for perioperative management.
• Point-of-care (POC) devices offer rapid assessment of platelet function and viscoelastic properties.

Purpose of the Study:

• To evaluate platelet function and viscoelastic blood properties using POC devices (Multiplate®, Siemens PFA-200®, ROTEM®) pre- and postoperatively.
• To investigate the association between preoperative POC test results and perioperative bleeding outcomes.
• To assess postoperative changes in hemostatic properties and agreement between POC devices.

Main Methods:

• Prospective observational study of 63 patients undergoing elective CABG surgery.
• Assessment of hemostatic properties using Multiplate® (ASPI, ADP tests), Siemens INNOVANCE® PFA-200® (PFA Collagen/EPI, Collagen/ADP, PFA P2Y tests), and ROTEM® delta.
• POC tests performed preoperatively and on postoperative day 4.
• Primary outcome: perioperative bleeding and transfusion requirements (UDPB score).

Main Results:

• Patients with excessive bleeding received more packed red blood cells (PRBCs) (87.5% vs. 48.9%, p=0.007).
• Preoperative FIBTEM A30 significantly correlated with excessive bleeding (Rho=-0.280, p=0.028) and predicted 24-hour chest tube output (CTO) (R Square=0.108, p=0.009).
• A preoperative FIBTEM A30 < 10.86 mm predicted excessive bleeding with 94% sensitivity.
• Multiplate ASPI test results were higher in patients with insignificant bleeding, indicating lower aspirin response.

Conclusions:

• Preoperative FIBTEM A30 is a strong predictor of excessive bleeding and CTO in CABG patients.
• Postoperative findings suggest platelet hyperreactivity and a shift towards hypercoagulability.
• Hemostatic management and antiplatelet therapy decisions should be guided by thromboelastometry and platelet function testing.