Download PDF
Thorac Cardiovasc Surg 2013; 61(08): 733-743
DOI: 10.1055/s-0033-1333659
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

The Predictive Value of Multiple Electrode Platelet Aggregometry (Multiplate) in Adult Cardiac Surgery

Christoph Schimmer
1   Department of Cardiothoracic and Thoracic Vascular Surgery, University of Würzburg, Würzburg, Germany
,
Khaled Hamouda
1   Department of Cardiothoracic and Thoracic Vascular Surgery, University of Würzburg, Würzburg, Germany
,
Sebastian Patrick Sommer
1   Department of Cardiothoracic and Thoracic Vascular Surgery, University of Würzburg, Würzburg, Germany
,
Mehmet Özkur
1   Department of Cardiothoracic and Thoracic Vascular Surgery, University of Würzburg, Würzburg, Germany
,
Johannes Hain
2   Department of Statistics, Institute of Mathematics and Informatics, Chair of Mathematics VIII (Statistics), University of Würzburg, Würzburg, Germany
,
Rainer Leyh
1   Department of Cardiothoracic and Thoracic Vascular Surgery, University of Würzburg, Würzburg, Germany
› Author Affiliations
Further Information

Publication History

12 July 2012

24 October 2012

Publication Date:
18 February 2013 (online)

    Permissions and Reprints All articles of this category

Abstract

Background The purpose of this retrospective observational study is to analyze the value of multiple electrode platelet aggregometry (Multiplate analyzer, Verum Diagnostica, Munich) as a point-of-care (POC) device in adult cardiac surgical patients.

Methods Two hundred and twenty-three cardiac surgical patients were analyzed preoperatively and postoperatively with multiple electrode platelet aggregometry by stimulation ADPtest, ASPItest, and TRAPtest. End points were postoperative bleeding, need for reexploration, and perioperative transfusions requirements. Furthermore, a literature survey using the key phrases “platelet function” and “cardiac surgery” was performed.

Results When comparing patients with normal Multiplate test results concerning end points, patients with pathological ADPtest (n = 140) needed significant more platelet concentrates (PCs) (p = 0.009), patients with pathological ASPItest (n = 175) did not show any significant differences, and patients with pathological TRAPtest (n = 139) needed more red blood cells (p = 0.008) and PCs (p = 0.02). The literature survey showed 208 hits, spanning the publication years 2002 to 2012 resulted in 123 hits.

Conclusions The ADPtest and the TRAPtest significantly predict the requirement of perioperative blood transfusion. Therefore, multiple electrode platelet aggregometry is beneficial for POC testing in cardiac surgical patients. Prospective, randomized, and controlled clinical studies are rare.

Keywords

multiple electrode platelet aggregometry - cardiac surgery - POC testing - impedance aggregometry - platelet function analysis
 

  • References

  • 1 Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996; 111 (5) 1037-1046
    CrossrefPubMedGoogle Scholar
  • 2 Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med 2004; 30 (10) 1873-1881
    CrossrefPubMedGoogle Scholar
  • 3 Leong JY, Baker RA, Shah PJ, Cherian VK, Knight JL. Clopidogrel and bleeding after coronary artery bypass graft surgery. Ann Thorac Surg 2005; 80 (3) 928-933
    CrossrefPubMedGoogle Scholar
  • 4 Bracey AW, Grigore AM, Nussmeier NA. Impact of platelet testing on presurgical screening and implications for cardiac and noncardiac surgical procedures. Am J Cardiol 2006; 98 (10A) 25N-32N
    PubMedGoogle Scholar
  • 5 Gravlee GP, Arora S, Lavender SW , et al. Predictive value of blood clotting tests in cardiac surgical patients. Ann Thorac Surg 1994; 58 (1) 216-221
    CrossrefPubMedGoogle Scholar
  • 6 Hall TS, Sines JC, Spotnitz AJ. Hemorrhage related reexploration following open heart surgery: the impact of pre-operative and post-operative coagulation testing. Cardiovasc Surg 2002; 10 (2) 146-153
    CrossrefPubMedGoogle Scholar
  • 7 Reinhöfer M, Brauer M, Franke U, Barz D, Marx G, Lösche W. The value of rotation thromboelastometry to monitor disturbed perioperative haemostasis and bleeding risk in patients with cardiopulmonary bypass. Blood Coagul Fibrinolysis 2008; 19 (3) 212-219
    CrossrefPubMedGoogle Scholar
  • 8 Shore-Lesserson L. Evidence based coagulation monitors: heparin monitoring, thromboelastography, and platelet function. Semin Cardiothorac Vasc Anesth 2005; 9 (1) 41-52
    CrossrefPubMedGoogle Scholar
  • 9 Petricevic M, Biocina B, Milicic D , et al. Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery. J Thromb Thrombolysis 2012; ; [Epub ahead of print]
    PubMedGoogle Scholar
  • 10 Weber CF, Görlinger K, Meininger D , et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012; 117 (3) 531-547
    CrossrefPubMedGoogle Scholar
  • 11 Görlinger K, Dirkmann D, Hanke AA , et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 2011; 115 (6) 1179-1191
    PubMedGoogle Scholar
  • 12 Ranucci M, Baryshnikova E, Soro G, Ballotta A, De Benedetti D, Conti D. Surgical and Clinical Outcome Research (SCORE) Group. Multiple electrode whole-blood aggregometry and bleeding in cardiac surgery patients receiving thienopyridines. Ann Thorac Surg 2011; 91 (1) 123-129
    CrossrefPubMedGoogle Scholar
  • 13 Solomon C, Hartmann J, Osthaus A , et al. Platelet concentrates transfusion in cardiac surgery in relation to preoperative point-of-care assessment of platelet adhesion and aggregation. Platelets 2010; 21 (3) 221-228
    CrossrefPubMedGoogle Scholar
  • 14 Rahe-Meyer N, Winterhalter M, Boden A , et al. Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry. Acta Anaesthesiol Scand 2009; 53 (2) 168-175
    CrossrefPubMedGoogle Scholar
  • 15 Mahla E, Suarez TA, Bliden KP , et al. Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: the timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study. Circ Cardiovasc Interv 2012; 5 (2) 261-269
    CrossrefPubMedGoogle Scholar
  • 16 Görlinger K, Jambor C, Hanke AA , et al. Perioperative coagulation management and control of platelet transfusion by point-of-care platelet function analysis. Transfus Med Hemother 2007; 34 (6) 396-411
    CrossrefPubMedGoogle Scholar
  • 17 Mahmud E, Cavendish JJ, Tsimikas S , et al. Elevated plasma fibrinogen level predicts suboptimal response to therapy with both single- and double-bolus eptifibatide during percutaneous coronary intervention. J Am Coll Cardiol 2007; 49 (22) 2163-2171
    CrossrefPubMedGoogle Scholar
  • 18 Velik-Salchner C, Haas T, Innerhofer P , et al. The effect of fibrinogen concentrate on thrombocytopenia. J Thromb Haemost 2007; 5 (5) 1019-1025
    CrossrefPubMedGoogle Scholar
  • 19 Ang L, Palakodeti V, Khalid A , et al. Elevated plasma fibrinogen and diabetes mellitus are associated with lower inhibition of platelet reactivity with clopidogrel. J Am Coll Cardiol 2008; 52 (13) 1052-1059
    CrossrefPubMedGoogle Scholar
  • 20 Lang T, Johanning K, Metzler H , et al. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia. Anesth Analg 2009; 108 (3) 751-758
    CrossrefPubMedGoogle Scholar
  • 21 Görlinger K, Oprea G, Peters J, Hartmann M. Fibrinogen reverses the eptifibatide-induced decrease of maximum clot firmness but not impaired platelet aggregation. J Cardiothorac Vasc Anesth 2010; 24 (3, Suppl) S35-S39
    PubMedGoogle Scholar
  • 22 Cammerer U, Dietrich W, Rampf T, Braun SL, Richter JA. The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg 2003; 96 (1) 51-57
    CrossrefPubMedGoogle Scholar
  • 23 Hanke AA, Roberg K, Monaca E , et al. Impact of platelet count on results obtained from multiple electrode platelet aggregometry (Multiplate). Eur J Med Res 2010; 15 (5) 214-219
    CrossrefPubMedGoogle Scholar
  • 24 Weant KA, Flynn JF, Akers WS. Management of antiplatelet therapy for minimization of bleeding risk before cardiac surgery. Pharmacotherapy 2006; 26 (11) 1616-1625
    CrossrefPubMedGoogle Scholar
  • 25 Poston R, Gu J, Manchio J , et al. Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting. Eur J Cardiothorac Surg 2005; 27 (4) 584-591
    CrossrefPubMedGoogle Scholar
  • 26 Avidan MS, Alcock EL, Da Fonseca JP , et al. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. Br J Anaesth 2004; 92 (2) 178-186
    CrossrefPubMedGoogle Scholar
  • 27 Hertfelder HJ, Bös M, Weber D, Winkler K, Hanfland P, Preusse CJ. Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting. Semin Thromb Hemost 2005; 31 (4) 426-440
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Forestier F, Coiffic A, Mouton C, Ekouevi D, Chêne G, Janvier G. Platelet function point-of-care tests in post-bypass cardiac surgery: are they relevant?. Br J Anaesth 2002; 89 (5) 715-721
    CrossrefPubMedGoogle Scholar
  • 29 Lennon MJ, Gibbs NM, Weightman WM, McGuire D, Michalopoulos N. A comparison of Plateletworks and platelet aggregometry for the assessment of aspirin-related platelet dysfunction in cardiac surgical patients. J Cardiothorac Vasc Anesth 2004; 18 (2) 136-140
    CrossrefPubMedGoogle Scholar
  • 30 Weber CF, Dietrich W, Spannagl M, Hofstetter C, Jámbor C. A point-of-care assessment of the effects of desmopressin on impaired platelet function using multiple electrode whole-blood aggregometry in patients after cardiac surgery. Anesth Analg 2010; 110 (3) 702-707
    CrossrefPubMedGoogle Scholar
  • 31 Keyl C, Kmitta E, Kueri S, Zietak T, Trenk D. Effects of aspirin and desmopressin on platelet reactivity in patients undergoing cardiac surgery with extracorporeal circulation. Thromb Haemost 2011; 105 (1) 113-121
    PubMedGoogle Scholar
  • 32 Bevilacqua S, Alkodami AA, Volpi E , et al. Risk stratification after coronary artery bypass surgery by a point-of-care test of platelet function. Ann Thorac Surg 2009; 87 (2) 496-502
    CrossrefPubMedGoogle Scholar
  • 33 Blome M, Isgro F, Kiessling AH , et al. Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery. Thromb Haemost 2005; 93 (6) 1101-1107
    PubMedGoogle Scholar
  • 34 Ucar HI, Oc M, Tok M , et al. Preoperative fibrinogen levels as a predictor of postoperative bleeding after open heart surgery. Heart Surg Forum 2007; 10 (5) E392-E396
    CrossrefPubMedGoogle Scholar
  • 35 Karlsson M, Ternström L, Hyllner M, Baghaei F, Nilsson S, Jeppsson A. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion 2008; 48 (10) 2152-2158
    CrossrefPubMedGoogle Scholar
  • 36 Karlsson M, Ternström L, Hyllner M , et al. Prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass surgery. A prospective randomised pilot study. Thromb Haemost 2009; 102 (1) 137-144
    PubMedGoogle Scholar
  • 37 Ternström L, Radulovic V, Karlsson M , et al. Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: a prospective observational study. Thromb Res 2010; 126 (2) e128-e133
    CrossrefPubMedGoogle Scholar