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

Objectives: This study sought to determine the platelet function and viscoelastic blood properties in the pre- and postoperative period using three different point-of-care (POC) devices (Multiplate^®, Siemens PFA-200^® and ROTEM^®). We aimed to investigate the association between preoperative POC test results and bleeding outcomes. Postoperative changes in blood hemostatic properties were also evaluated, as well as the agreement between two platelet function analyzers and rotational thromboelastometry parameters. Methods: The study was conducted in a prospective observational fashion. Patients undergoing elective coronary artery bypass graft surgery (CABG) were enrolled. Hemostatic blood properties were assessed using three different POC devices; two platelet function analyzers were used: (1) Impedance aggregometry (Multiplate^®) with the arachidonic acid (ASPI) test and adenosine diphosphate (ADP) test. (2) The Siemens INNOVANCE^® PFA-200 System with the following assays: the PFA Collagen/EPI test, PFA Collagen/ADP test, and the INNOVANCE^® PFA P2Y test. Viscoelastic blood properties were assessed using ROTEM^® delta (TEM Innovations GmbH, Munich, Germany). POC tests were performed simultaneously at two different time points: (1) before surgery and (2) on postoperative day 4, respectively. The primary outcome was defined as amounts of perioperative bleeding and transfusion requirements, classified according to the universal definition for perioperative bleeding (UDPB) score. Results: The study recruited a total number of 63 patients undergoing elective isolated coronary artery bypass graft surgery (CABG). Based on the packed red blood cell (PRBC) transfusion requirements, patients with excessive bleeding were not just only frequently transfused (87.5% vs. 48.9%, p = 0.007) but were also transfused with higher amounts of PRBCs (1338.75 mL ± SD 1416.49 vs. 289.36 mL ± 373.07, p < 0.001). The FIBTEM A30 results significantly correlated with excessive bleeding (Correlation Coefficient Rho = -0.280, p = 0.028). Regression analysis revealed FIBTEM A 30 as a strongest predictor of 24 h chest tube output (CTO) (R Square 0.108, p = 0.009). The receiver operating characteristics curve (ROC) analysis showed that a preoperative FIBTEM A30 < 10.86 mm predicted excessive bleeding with 94% sensitivity and 50% specificity (ROC AUC 68.4%). The multiplate ASPI test results were significantly higher (35.24 AUC ± SD 22.24 vs. 19.43 AUC ± SD 10.74) and the proportion of Aspirin responders was significantly lower (42.4% vs. 76.7%, p = 0.006) in patients considered to have insignificant bleeding. On postoperative day 4, we found platelet hyperreactivity in the ASPItest coupled with a ROTEM-documented shift towards hypercoagulability. Conclusions: Modern hemostatic management and perioperative antiplatelet therapy (APT) administration/discontinuation management should be guided by thromboelastometry and platelet function testing. Prospective interventional trials are necessary to validate such an approach in multicentric studies.