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The Annals of Thoracic Surgery, Vol 57, 981-986, Copyright © 1994 by The Society of Thoracic Surgeons
MJ Ray, GA Hawson, SJ Just, G McLachlan and M O'Brien
Excessive bleeding after cardiopulmonary bypass operations is a persistent
problem. This study assessed the influence of platelet function on blood
loss for 134 patients undergoing cardiopulmonary bypass. Platelet function
was measured by platelet aggregation in platelet-rich plasma and whole
blood using collagen as the agonist. Adenosine triphosphate release was
assessed concurrently. Measurements were made 1 day before operation and 1
hour after the cessation of cardiopulmonary bypass. Three important
findings were made. First, statistically significant correlations were
shown between preoperative and postoperative platelet aggregation and blood
drainage for the first 3 hours postoperatively. Second, correlations were
greatest when preoperative measurement was performed on whole blood and
postoperative measurement was performed on platelet-rich plasma. Third,
patients with reduced postoperative platelet aggregation in platelet-rich
plasma had significantly greater transfusion requirements in the first 24
hours postoperatively. In defining the 16 patients who bled excessively
among the 134 patients studied, the preoperative aggregation in whole blood
had a sensitivity of 62%, specificity of 75%, positive predictive value of
26%, and negative predictive value of 94%. The postoperative aggregation in
platelet-rich plasma had a sensitivity of 86%, specificity of 69%, positive
predictive value of 28%, and negative predictive value of 97%. These
results indicate that preoperative and postoperative measurement of
platelet aggregation may provide a rationale for the prophylaxis or
treatment of patients to reduce blood loss after cardiopulmonary bypass.
ARTICLES
Relationship of platelet aggregation to bleeding after cardiopulmonary bypass
Department of Haematology, Prince Charles Hospital, Brisbane, Australia.
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