Early platelet recovery following cardiac surgery with cardiopulmonary bypass

Autor: Gerhardus J.A.J.M. Kuiper, Rick J. H. Wetzels, Maurice Theunissen, Marcus D. Lancé, Yvonne M. C. Henskens, Cécile H. Kicken, Rene van Oerle, Paul W.M. Verhezen, Sven Van Poucke, Kris N.J. Stevens
Přispěvatelé: Biochemie, MUMC+: MA AIOS Anesthesiologie (9), MUMC+: MA Anesthesiologie (9), MUMC+: DA CDL Analytisch cluster 1K (9), Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA CDL Algemeen (9), RS: CARIM - R1.04 - Clinical thrombosis and haemostasis
Rok vydání: 2016
Předmět:
Male
COUNT
multiple electrode impedance aggregometry
MULTIPLE ELECTRODE AGGREGOMETRY
LIGHT TRANSMISSION AGGREGOMETRY
MULTIPLATE(TM)
Coronary Artery Disease
rotational thromboelastometry
030204 cardiovascular system & hematology
Hematocrit
law.invention
Coronary artery disease
0302 clinical medicine
030202 anesthesiology
law
Platelet
Postoperative Period
Coronary Artery Bypass
Blood coagulation test
COAGULOPATHY
medicine.diagnostic_test
Cardiopulmonary bypass
Hematology
General Medicine
Middle Aged
Thrombelastography
Cardiac surgery
Thromboelastometry
Treatment Outcome
surgical procedures
operative
platelet aggregation
Anesthesia
Cardiology
Female
Blood Coagulation Tests
medicine.medical_specialty
Platelet Function Tests
03 medical and health sciences
Internal medicine
platelet activation
WHOLE-BLOOD
medicine
Humans
Platelet activation
Aged
Platelet Count
business.industry
THROMBOCYTOPENIA
THROMBOELASTOMETRY
Thrombosis
AGGREGATION
COAGULATION MANAGEMENT
medicine.disease
business
Zdroj: Platelets, 27(8), 751-757. Routledge/Taylor & Francis Group
ISSN: 1369-1635
0953-7104
DOI: 10.3109/09537104.2016.1173665
Popis: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is frequently associated with low platelet count (PC) and disturbed platelet function (PF). While PC is easy to measure, PF is more difficult to assess. Moreover, the time-related platelet dysfunction and recovery after CPB is not fully elucidated. Platelet dysfunction could lead to bleeding but also to coronary graft failure. Laboratory tests could provide more insights into PF after CABG. The aim of the current study was to investigate the time-related PF induced by CPB. Blood samples of 20 patients with a preoperative PC of more than 250 x 10(9)/L were collected before incision, after weaning from CPB, and 24 h postoperative. Platelet contribution to coagulation was quantified by PLTEM (calculated by means of EXTEM and FIBTEM results). PF was assessed by multiple electrode impedance aggregometry (MEIA) in whole blood and by light transmission aggregometry (LTA) in platelet-rich plasma after stimulation with arachidonic acid (AA), adenosine diphosphate, collagen, and thrombin-receptor-activating peptide. LTA and MEIA analysis demonstrated significant platelet dysfunction after CPB, with partial recovery within 24 h after surgery. AA-induced platelet aggregation increased to higher levels within 24 h after surgery compared to baseline values as measured by LTA. PLTEM maximum clot firmness remained unchanged throughout the study. Correlation analyses revealed that MEIA and rotational thromboelastometry (ROTEM), but not LTA, were dependent on PC and hematocrit. No correlations were found between LTA, MEIA, ROTEM, PC, and clinical outcome parameters. Our results demonstrate a reversible platelet dysfunction recovering within 24 h after CPB. Interestingly, AA-induced platelet aggregation increases to higher levels during the first 24 h postoperatively, which might be important for early initiation of antiplatelet therapy after CABG. MEIA as POC test is able to detect platelet dysfunction during cardiac surgery with a PC of >= 150 x 10(9)/L.
Databáze: OpenAIRE
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