Transfusion requirements in elective cardiopulmonary bypass surgery patients: predictive value of Multiplate and Thromboelastography (TEG) Platelet Mapping Assay

Autor: Sisse R. Ostrowski, Praleene Sivapalan, Anne Caroline Bäck, Pär I. Johansson, Hanne Berg Ravn
Rok vydání: 2017
Předmět:
Blood Platelets
Male
medicine.medical_specialty
Mitral Valve Annuloplasty
Platelet Aggregation
Platelet Function Tests
medicine.medical_treatment
Clinical Biochemistry
Platelet Transfusion
030204 cardiovascular system & hematology
law.invention
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
law
medicine
Cardiopulmonary bypass
Humans
Platelet
Prospective Studies
030212 general & internal medicine
Coronary Artery Bypass
Aged
Hemostasis
Arachidonic Acid
Cardiopulmonary Bypass
medicine.diagnostic_test
business.industry
Mitral valve replacement
General Medicine
Middle Aged
Intensive care unit
Thromboelastography
Thrombelastography
Surgery
Cardiac surgery
Adenosine Diphosphate
Intensive Care Units
medicine.anatomical_structure
Elective Surgical Procedures
Anesthesia
Female
Fresh frozen plasma
business
Artery
Zdroj: Scandinavian Journal of Clinical and Laboratory Investigation. 77:345-351
ISSN: 1502-7686
0036-5513
DOI: 10.1080/00365513.2017.1325000
Popis: Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA were performed at baseline (after anaesthesia induction), upon arrival at the intensive care unit and on the first postoperative day. Patients receiving fresh frozen plasma and/or platelets (FFP/PLT) had a lower PMA maximum amplitude (MA) for adenosine diphosphate (PMA-ADP) and arachidonic acid (PMA-AA) at baseline, at arrival in the intensive care unit and the first postoperative day compared to non-transfused patients. Receiver operating characteristic curves on PMA showed that lower values predicted FFP/PLT transfusion: PMA-ActF 0.64 (p = 0.04), PMA-ADP 0.69 (p = 0.01) and PMA-AA 0.71 (p = 0.002). In contrast, MEA values were not able to predict FFP/PLT transfusions. This study shows that preoperative PMA potentially is a better screening tool for platelet inhibition associated with transfusion requirements in patients undergoing CABG or combined procedures.
Databáze: OpenAIRE
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