British Journal of Anaesthesia, 2002, Vol. 89, No. 5 715-721
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Platelet function point-of-care tests in post-bypass cardiac surgery: are they relevant?
1 Department of Anaesthesia II and 2 Haemobiology Laboratory, Hôpital cardiologique, CHU de Bordeaux, Avenue de Magellan, F-33604 Pessac cedex, France. 3 INSERM Unit 330, Victor Segalen Bordeaux 2 University, Bordeaux, France*Corresponding author
Background. Platelet dysfunction is an important cause of excessive bleeding after cardiac surgery. We assessed two platelet function point-of-care tests: the platelet function analyser (PFA-100) and the HemostatusTM in patients with and without excessive bleeding after cardiac surgery with cardiopulmonary bypass.
Methods. Mediastinal chest tube drainage (MCTD) was measured for the first 6 h in the intensive care unit (ICU). Haematology and coagulation tests were done on arrival in the ICU, and when excessive bleeding occurred (MCTD >1 ml kg–1 h–1) or after 3 h.
Results. Eighteen patients bled excessively and 27 had normal MCTD. Hemostatus measurements were prolonged in those with excessive bleeding compared with the normal group. The times for PFA-100 adenosine diphosphate (ADP) and epinephrine were 91 vs 71 s (P=0.004) and 155 vs 114 s (P=0.02) in the bleeding and normal group s, respectively. None of the Hemostatus or PFA-100 values correlated with total MCTD. Depending on the agonist used, maximum aggregation was 33–81% and 52–86% in bleeding and normal groups, respectively. Only poor correlations were found between PFA-100 epinephrine and maximum aggregation in response to ADP (r=–0.52, P=0.03) or to collagen (r=–0.48, P=0.04).
Conclusion. Patients bleeding excessively in the ICU had abnormal measurements in point-of-care tests without a dramatic decrease in aggregation. Except for patients with increased risk of postbypass bleeding, point-of-care tests are not useful for routine use after cardiac surgery.
Br J Anaesth 2002; 89: 715–21
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