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Does platelet size correlate with function in patients undergoing cardiac surgery?
J Boldt1, B Zickmann, M Benson
1Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Insights
Platelet size, measured by mean platelet volume (MPV), decreased during cardiopulmonary bypass (CPB) and correlated with impaired platelet function. MPV may indicate platelet dysfunction after cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) in cardiac surgery can lead to nonsurgical post-operative bleeding due to platelet dysfunction.
- Assessing platelet function is crucial for managing bleeding risks in these patients.
Purpose of the Study:
- To investigate if platelet size, specifically mean platelet volume (MPV), serves as an indicator of platelet function in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Prospective study involving 80 patients undergoing CABG, excluding those with pre-operative coagulation disorders or recent anticoagulant use.
- Platelet function assessed via aggregometry (ADP, collagen, epinephrine).
- Mean platelet volume (MPV) measured using electrical conductivity; measurements taken before, during, and after CPB, including the first post-operative day.
Main Results:
- Platelet size (MPV) significantly decreased during CPB, with maximum reduction post-weaning, returning to baseline by post-operative day 1.
- CPB significantly reduced platelet aggregation induced by ADP and collagen.
- A significant correlation was found between changes in MPV and changes in platelet aggregation variables (ADP, collagen).
Conclusions:
- Mean platelet volume (MPV) is easily measurable in the perioperative setting (OR/ICU).
- MPV changes correlate with impaired platelet function following CPB.
- Platelet volume may serve as a valuable indicator of platelet dysfunction in cardiac surgery patients post-bypass.
Objective:
Platelet dysfunction secondary to cardiopulmonary bypass (CPB) is one of the major reasons for nonsurgical post-operative bleeding in cardiac surgery. Whether platelet size is an indicator for platelet function was investigated in patients undergoing coronary artery bypass grafting.
Design:
Prospective study.
Setting:
Intra-operative, cardiac surgery operations.
Patients:
80 consecutive patients undergoing coronary artery bypass grafting. Excluding criteria were pre-operative coagulation disorders and medication with anticoagulants within the last 10 days before the operation day.
Measurements And Results:
Platelet function was assessed by aggregometry using a turbidimetric method (inductors: ADP 2.0 mumol/l, collagen 4 micrograms/l, epinephrine 25 mumol/l). Mean platelet volume (MPV) was measured by an electrical conductivity method. Measurements were carried out before, during, and after CPB until the 1st post-operative day on intensive care unit (ICU). Platelet size decreased significantly during CPB (max. -25% after weaning from bypass) and returned to baseline values on the 1st post-operative day. Platelet count (ranging from 93 - 304 x 10(9)/l) did not correlate significantly with MPV or aggregation variables. Maximum aggregation and maximum gradient of aggregation induced by ADP and collagen were significantly decreased by CPB with the most pronounced reduction at the end of CPB (ranging from -25% to -45%). Analyses of co-variance revealed a significant correlation between changes in MPV and changes in aggregation variables (ADP, collagen).
Conclusions:
Platelet volume is easy to measure even in the operation room or in ICU and may indicate abnormalities in platelet function in the post-bypass period of cardiac surgery patients.