Blood Management in the OR: Does Quantification of Platelet Function Help Optimize Postoperative Outcome?

Background: Almost all patients undergoing cardiac surgery take platelet aggregation inhibitor drugs. Moreover, in case of an emergent or urgent admission it is often unclear which medication was taken and when the last intake was. Thus, the P2Y12 status of the platelets of these patients is unknown but can have dangerous consequences such as bleeding problems or thromboembolic complications. In our study we investigated the postoperative outcome of these patients using Point of care test (POCT) for checking preoperative platelet function by measurement of P2Y12 status.

Method: A total of 546 patients with urgent or emergent procedures were included in our study (inclusion criteria: drug ingestion for inhibition of platelets and operation within 24 hours). Using POCT we measured the P2Y12 status and established a stratified therapeutic protocol depending on platelet function. Patients with normal platelet function did not receive special therapy. Patients with mild inhibition received Desmopressin and patients with marked inhibition received platelet concentrates. We looked at the postoperative course of these patients and compared it with elective patients.

Results: There were no significant differences between our treatment group compared with the standard group of our hospital (n = 584) (early rethoracotomy 2.7% vs. 2.9%; number of transfusion units 1.04 vs. 1.03, postoperative wound healing problems 3.1 versus 2.9%, thromboembolic complications 0.4 vs. 0.3%).

Conclusion: In our study, we saw a normal postoperative course of these high risk patients. POCT is easy to use and inexpensive. Our stratified therapy is safe for our patients, resulted in a comparable clinical outcome of this risk group compared with elective patients and is cost-effective.

Publication History

Article published online:
28 January 2023