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Ann Thorac Surg 2000;70:S20-S32
© 2000 The Society of Thoracic Surgeons

Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery

^a Departments of Department of Anesthesiology, Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
^b Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA

Address reprint requests to Dr Despotis, Department of Anesthesiology, Box 8054, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110
e-mail: despotig{at}notes.wustl.edu

Presented at the "Managing the Patient Receiving Platelet Inhibitors in Cardiac Surgery" Roundtable Discussion, San Antonio, TX, Jan 22–23, 1999.

Patients undergoing cardiac surgery with cardiopulmonary bypass are at increased risk for microvascular bleeding that requires perioperative transfusion of blood components. Platelet-related defects have been shown to be the most important hemostatic abnormality in this setting. The exact association between preoperative use of potent platelet inhibitors and either bleeding or transfusion in patients undergoing cardiac surgical procedures is currently being defined. Laboratory evaluation of platelets and coagulation factors can facilitate the optimal administration of pharmacologic and transfusion-based therapy. However, their turnaround time makes laboratory-based methods impractical for concurrent management of surgical patients, which has led many investigators to study the role of point-of-care coagulation tests in this setting. Use of point-of-care tests of hemostatic function can optimize the management of excessive bleeding and reduce transfusion. Accordingly, point-of-care tests that assess platelet function may also identify patients at risk for acquired, platelet-related bleeding. The ability to reduce the unnecessary use of blood products and to decrease operative time or reexploration rates has important consequences for blood inventory, blood costs, and overall health care costs.

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