Khalaf Adeli Elham, Mostafa Alavi Seyed, Alizadeh-Ghavidel Alireza, Bakhshandeh-Abkenar Hooman, Pourfathollah Ali Akbar
Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Jul 10;31:37. doi: 10.14196/mjiri.31.37. eCollection 2017.
Patients undergoing cardiac surgery are at increased risk of bleeding due to multifactorial coagulopathies. In the present study, we aimed at investigating the changes in platelet count and function during and after surgery as well as determining the association of the platelet dysfunction with bleeding and transfusion requirements in these patients. A total of 40 adult patients scheduled for elective valve coronary cardiac surgery were included in this prospective observational study. Changes in platelet count and function with ADP, acid arachidonic, and collagen (light transmission aggregometry) were analyzed at three time points: before CPB, after CPB, and 24 hours after end of surgery. Postoperative bleeding and intraoperative transfusion requirements were recorded. There were a significant reverse correlation between CPB time and ADP-induced aggregation, particularly after CPB and postoperative AA-induced aggregation. There was not any significant correlation between platelet count and function at all-time points. Both platelet count and platelet aggregation significantly reduced during CPB. While platelet aggregation increased on postoperative Day 1, platelet count reduced by about 40% after CPB, and remained at this level postoperatively. Patients with abnormal ADP-induced aggregation had significant increased postoperative bleeding and transfusion requirements. The results of this study demonstrate that platelet count and platelet aggregation are reduced during CPB. Our results emphasized the effect of platelet dysfunction on increased postoperative bleeding and transfusion requirements. Perioperative monitoring of platelet function can be considered as a bleeding management strategy for implantation of PBM programs.
接受心脏手术的患者由于多因素凝血障碍而有出血风险增加。在本研究中，我们旨在调查手术期间及术后血小板计数和功能的变化，并确定这些患者血小板功能障碍与出血及输血需求之间的关联。本前瞻性观察性研究纳入了40例计划接受择期瓣膜冠状动脉心脏手术的成年患者。在三个时间点分析血小板计数和功能随二磷酸腺苷（ADP）、花生四烯酸和胶原蛋白（光透射聚集法）的变化：体外循环（CPB）前、CPB后以及手术结束后24小时。记录术后出血情况和术中输血需求。CPB时间与ADP诱导的聚集之间存在显著的负相关，尤其是在CPB后以及术后花生四烯酸诱导的聚集。在所有时间点，血小板计数与功能之间均无显著相关性。在CPB期间，血小板计数和血小板聚集均显著降低。虽然术后第1天血小板聚集增加，但CPB后血小板计数降低约40%，并在术后维持在该水平。ADP诱导聚集异常的患者术后出血和输血需求显著增加。本研究结果表明，CPB期间血小板计数和血小板聚集降低。我们的结果强调了血小板功能障碍对术后出血增加和输血需求的影响。围手术期血小板功能监测可被视为实施患者血液管理（PBM）计划的出血管理策略。
