scholarly journals The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis

Anaesthesia ◽  
2015 ◽  
Vol 70 (6) ◽  
pp. 715-731 ◽  
Author(s):  
C. Corredor ◽  
M. Wasowicz ◽  
K. Karkouti ◽  
V. Sharma
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Platelet Function ◽  
Point Of Care ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Platelet Function Testing ◽  
Function Testing

scholarly journals Point-of-Care Platelet Function Testing in Cardiac Surgery: A Bundle of Measures Create Adequate Hemostatic Algorithm

2015 ◽  
Vol 29 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Mate Petricevic ◽  
Martina Zrno Mihaljevic ◽  
Marko Boban ◽  
Alexandra White ◽  
Bojan Biocina
Keyword(s):  
Cardiac Surgery ◽  
Platelet Function ◽  
Point Of Care ◽  
Platelet Function Testing ◽  
Function Testing

scholarly journals The Use of Point-of-care Testing in Detecting Platelet Function Recovery in a Patient Treated with Prasugrel Undergoing Urgent Surgical Revascularization

2021 ◽  
Author(s):  
Alessandra Verzelloni Sef ◽  
Francesca Caliandro ◽  
Davorin Sef ◽  
Shahzad Raja
Keyword(s):  
Platelet Function ◽  
Waiting Time ◽  
Point Of Care ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Function Recovery ◽  
Patients At Risk ◽  
Function Testing

A recent administration of potent P2Y12 receptor inhibitor such as prasugrel in patients undergoing cardiac surgery remains a dilemma and little is known about its impact on platelet function recovery. Guidelines recommend discontinuation of prasugrel 7 days before surgery to reduce the risk of surgery-related bleeding. Patients at risk may benefit from preoperative platelet function testing to guide individualized preoperative waiting time. We present a rare case of complete function recovery in a patient treated with prasugrel revealed by preoperative platelet function monitoring before urgent coronary artery bypass surgery (CABG). A complete platelet function recovery was revealed by platelet function testing after discontinuation of prasugrel for four days and patient underwent urgent CABG without increased risk of postoperative bleeding. Our case with a review of literature emphasized that the decision to proceed with urgent CABG in a patient recently treated with prasugrel should be based on a personalized risk assessment and might be supported by preoperative platelet function monitoring to shorten the waiting time.

Perioperative point of care platelet function testing and postoperative blood loss in high-risk cardiac surgery patients

Platelets ◽  
2018 ◽  
Vol 30 (8) ◽  
pp. 982-988 ◽  
Author(s):  
Eline A. Vlot ◽  
Laura M. Willemsen ◽  
Eric P.A. Van Dongen ◽  
Paul W. Janssen ◽  
Christian M. Hackeng ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Blood Loss ◽  
Platelet Function ◽  
Point Of Care ◽  
Postoperative Blood Loss ◽  
Platelet Function Testing ◽  
Function Testing

scholarly journals Platelet Function Testing for Cardiac Surgery Patients on Antiplatelet Therapy: The Extreme Variability of Point-Of-Care Tests

2018 ◽  
Vol 11 (2) ◽  
pp. 593-607
Author(s):  
Beatrice O. Ondondo
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Point Of Care ◽  
Cardiac Patients ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Extreme Variability ◽  
Point Of Care Tests ◽  
Function Testing

Platelets play a pivotal role in coagulation, and both quantitative and qualitative platelet defects can lead to major bleeding during and after surgery. Moreover, patients with cardiac disease are often on antiplatelet therapies as part of routine management, which predisposes to increased risk of perioperative bleeding due to inhibited platelet function. In some cases, antiplatelet therapy is interrupted briefly before scheduled cardiac surgery in order to reduce the risk of haemorrhage; however, this can increase the risk of perioperative thrombosis if not monitored carefully. Furthermore, individual patients respond differently to antiplatelet therapy. Therefore, point-of-care tests that determine platelet function could provide improved, personalised evidence-based treatment and management of such high-risk cardiac patients. This article reviewed various methods and devices used for testing platelet function at point-of-care in cardiac patients on antiplatelet therapy who were undergoing cardiac surgery. The consensus is that point-of-care testing of platelet function can offer three main advantages for the timely management of preoperative and perioperative coagulation in cardiac surgery patients who are on antiplatelet therapy: 1.) Assessing the effectiveness of antiplatelet therapy to quickly identify patients with resistance, who have increased risk of pre- and perioperative thrombotic events. 2.) Assessing platelet function recovery following treatment withdrawal to determine optimal timings for cardiac surgery, in order to avoid excessive haemorrhage, and reduce waiting times and hospitalisation costs for patients scheduled for cardiac surgery. 3.) Efficient use of transfusion blood products. However, an important finding of this review is that there exists extreme variability and a lack of correlation among the various point-of-care platelet function testing assays. Furthermore, the assays show inconsistencies in predicting blood loss, or adverse thrombotic and haemorrhagic events in cardiac patients on antiplatelet therapy and those undergoing surgery. It is imperative that point-of-care platelet function tests accurately predict the risks of bleeding and thrombosis in order to be clinically relevant in the preoperative, perioperative and long-term post-operative care and management of cardiac surgery patients on antiplatelet therapy. The extreme variability of these tests, coupled with inconsistencies in predicting adverse events do not support the high costs of large-scale implementation.

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 138-144
Author(s):  
Helena Argiriadou ◽  
Polychronis Antonitsis ◽  
Anna Gkiouliava ◽  
Evangelia Papapostolou ◽  
Apostolos Deliopoulos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Correlation Coefficient ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Minimal Invasive ◽  
Elective Cardiac Surgery ◽  
Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

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