Bleeding risk assessment in patients undergoing elective cardiac surgery using ROTEM(®) platelet and Multiplate(®) impedance aggregometry.

Autor: Petricevic M; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Konosic S; Department of Anesthesiology, University Hospital Centre Zagreb, Zagreb, Croatia., Biocina B; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Dirkmann D; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany., White A; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Mihaljevic MZ; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Ivancan V; Department of Anesthesiology, University Hospital Centre Zagreb, Zagreb, Croatia., Konosic L; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Svetina L; University of Zagreb School of Medicine, Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia., Görlinger K; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.; TEM International GmbH, Munich, Germany.
Jazyk: angličtina
Zdroj: Anaesthesia [Anaesthesia] 2016 Jun; Vol. 71 (6), pp. 636-47. Date of Electronic Publication: 2016 Jan 13.
DOI: 10.1111/anae.13303
Abstrakt: Impaired platelet function is a major risk factor for peri-operative bleeding and transfusion. This prospective, observational study enrolled 101 consecutive patients undergoing elective cardiac surgery with cardiopulmonary bypass. Platelet function was assessed by two whole blood impedance aggregometers (ROTEM(®) platelet and Multiplate(®) ), using three different activators (arachidonic acid, adenosine diphosphate and thrombin receptor-activating peptide-6), at three peri-operative time points (before anaesthesia, after aortic declamping and 5-10 min after protamine administration). Platelet function was impaired over the time-course in all assays. Results after protamine administration demonstrated the best correlation with postoperative chest tube drainage. Patients with a chest tube drainage exceeding the 75th percentile of the entire study population, during the first 24 postoperative hours, were characterised to have excessive bleeding. Both devices provided similar predictability for postoperative chest tube drainage and red blood cell transfusion requirements. The latter was associated with the degree of platelet inhibition and the number of pathways inhibited determined respective cut-off values.
(© 2016 The Association of Anaesthetists of Great Britain and Ireland.)
Databáze: MEDLINE
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