A Study of Platelet Functions with a New Analyzer Using High Shear Stress (PFA100™) in Patients Undergoing Coronary Artery Bypass Graft

Summary

Platelet dysfunction can be a major factor in excessive bleeding following cardiopulmonary bypass (CBP). A rapid, specific and sensitive method to identify platelet dysfunction would be a useful tool for identifying patients at an increased risk of bleeding. The ability of PFA100™, an in vitro bleeding test, to predict increased bleeding risk linked to platelet dysfunction was tested in 146 patients undergoing primary coronary artery bypass graft. Blood samples were taken the day before surgery, and 15 min and 5 h after heparin neutralization. The preoperative closure times (CT), i. e. the time required for platelets in citrated whole blood to occlude an aperture cut into a membrane coated with collagen plus either epinephrine (CTEPI) or adenosine diphosphate (CTADP) were longer in blood-group-O patients than in patients with other groups. The 15 min postoperative values were significantly longer from preoperative values essentially owing to CBP-induced hemodilution. Interestingly, 5 h after CBP, a significant reduction in CT values probably reflected platelet hyperaggregability. No correlation was found between calculated blood loss (CBL) and either preoperative or postoperative PFA values.

Key words

Platelet function - cardiopulmonary bypass - PFA100™ - in vitro bleeding time

• References

• 1 Ivy AC, Nelson D, Bucher G. The standardization of certain factors in cutaneous “venostasis” bleeding time technique. J Lab Clin Med 1941; 26: 1812-22.
• 2 Lind SE. The bleeding time does not predict surgical bleeding. Blood 1991; 77: 2547-52.
• 3 De Caterina R, Lanza M, Manca G, Strata GB, Maffei S, Salvatore L. Bleeding time and bleeding: an analysis of the relationship of the bleeding time test with parameters of surgical bleeding. Blood 1994; 84: 3363-70.
• 4 Kundu SK, Heilmann EJ, Sio R, Garcia C, Davidson RM, Ostgaard RA. Description of an in vitro platelet function analyzer-PFA100. Semin Thromb Hemost 1995; 21 (Suppl. 02) 106-12.
• 5 Mammen EF, Alshameeri RS, Comp PC. Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost 1995; 21 (Suppl. 02) 113-21.
• 6 Fressinaud E, Veyradier A, Truchaud F, Martin I, Boyer-Neumann C, Trossaert M, Meyer D. Screening for von Willebrand disease with a new analyzer using high shear stress: a study of 60 cases. Blood 1998; 91: 1325-31.
• 7 Carcao MD, Blanchette VS, Dean JA, Kern MA, Stain AM, Sparling CR, Stephens D, Ryan G, Freedman J, Rand ML. The platelet function analyzer (PFA-100): a novel in-vitro system for evaluation of primary haemostasis in children. Br J Haematol 1998; 101: 70-3.
• 8 Cattaneo M, Federici AB, Lecchi A, Agati B, Lombardi R, Stabile F, Bucciarelli P. Evaluation of the PFA100® system in the diagnosis and therapeutic monitoring of patients with von Willebrand disease. Thromb Haemost 1999; 82: 35-9.
• 9 Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 1996; 13: 465-78.
• 10 Gill JC, Endres-Brooks J, Bauer PJ, Marks WJ, Montgomery RR. The effect of ABO blood group on the diagnosis of von Willebrand disease. Blood 1987; 69: 1691-5.
• 11 Harker LA, Malpass TW, Branson HE, Hessel II EA, Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha granule release. Blood 1980; 56: 824-34.
• 12 Holloway DS, Summaria L, Sandesara J, Vagher JP, Alexander JC, Caprini JA. Decreased platelet number and function and increased fibrinolysis contribute to post-operative bleeding in cardiopulmonary bypass patients. Thromb Haemost 1988; 59: 62-7.
• 13 Dechavanne M, French M, Pages J, French P, Boukerche H, Byron PA, McGregor JL. Significant reduction in the binding of a monoclonal antibody (LYP18) directed against the IIb/IIIa glycoprotein complex to platelets of patients having undergone extracorporeal circulation. Thromb Haemost 1987; 57: 106-9.
• 14 Ferraris V, Ferraris SP, Laugh FC, Berry WR. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting. Ann Thorac Surg 1988; 45: 71-4.
• 15 Goldman S. Veteran administration group. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy. Circulation 1988; 77: 1324-32.
• 16 Kundu SK, Sio R, Mitu A, Ostgaard R. Evaluation of platelet function by PFA-100. Clin Chem 1994; 40: 1827-8.
• 17 Ruggeri ZM, Dent JA, Salvidar E. Contribution of distinct adhesive interactions to platelet aggregation in flowing blood. Blood 1999; 94: 172-8.
• 18 Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Hemost 1998; 24: 195-202.
• 19 Whaba A, Sander S, Birnbaum DE. Are in-vitro platelet function tests useful in predicting blood loss following open heart surgery?. Thorac Cardiovasc Surg 1998; 46: 22-31.
• 20 Federici AB, Mannucci PM, Fogato E, Ghidoni P, Matturri L. Autopsy findings in three patients with von Willebrand disease type IIB and type III: presence of atherosclerotic lesions without occlusive arterial thrombi. Thromb Haemost 1993; 70: 758-61.
• 21 Escolar G, Cases A, Vinas M, Pino M, Calls J, Cirera I, Ordinas A. Evaluation of acquired platelet dysfunctions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100): influence of hematocrit elevation. Hematologica 1999; 84: 614-9.
• 22 Maquelin KN, Berckmans RJ, Nieuland R, Schaap MC, te Have K, Eijsman L, Sturk A. Disappearance of glycoprotein Ib from the platelet surface in pericardial blood during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 115: 1160-5.
• 23 Michelson AD, Barnard MR, Khuri SF, Rohere MJ, MacGregor H, Valeri CR. The effects of aspirin and hypothermia on platelet function in vivo. Br J Haematol 1999; 46: 228-31.
• 24 Slaughter TF, Sreeram GM, Sharma A, Greenberg CS. Shear-mediated platelet dysfunction during cardiac surgery: mechanism and clinical implications. Thromb Haemost 1999; Suppl: 74-4.
• 25 Holdright DR, Hunt BJ, Parratt R, Segal H, Clarke D, Taggart D, Bennett G, Collins P. The effects of cardiopulmonary bypass on systemic and coronary levels of von Willebrand factor. Eur J Cardio-thorac Surg 1995; 09: 18-21.
• 26 Perrin EJ, Ray MJ, Hawson GAT. The role of von Willebrand factor in haemostasis and blood loss during and after cardiopulmonary bypass. Blood Coag Fibrinol 1995; 06: 650-7.
• 27 Treib J, Haass A, Pindur G, Seyfert UT, Treib W, Grauer MT, Jung F, Wenzel E, Schmrigk K. HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl Starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost 1995; 74: 1452-6.