Association of Adenosine Diphosphate-Induced Platelet Maximum Amplitude With Postoperative Bleeding and Blood Transfusions in Patients Undergoing Coronary Artery Bypass Grafting.

OBJECTIVES

To investigate the association of adenosine diphosphate (ADP)-induced platelet maximum amplitude (MA) with postoperative bleeding and blood product transfusions in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

DESIGN

This single-center observational study recruited 200 patients who underwent elective, first-time, isolated CABG with CPB. A rapid thromboelastography with platelet mapping test was conducted for all patients before the surgery. Patients were categorized by the preoperative MA into ≤50 mm (MA ≤50 group [n = 87]) and MA >50 mm (MA >50 group [n = 113]). The primary outcome was postoperative bleeding at 6 and 24 hours as measured by chest tube drainage volume. The perioperative blood product transfusions, postoperative complications, postoperative time course, and in-hospital mortality also were evaluated.

SETTING

University hospital.

PARTICIPANTS

Adult patients scheduled to undergo isolated primary CABG with CPB.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The study included 200 patients who underwent CABG with CPB. MA was >50 mm in 113 (56.5%) patients (MA >50 group). Compared with the MA >50 group, the postoperative chest tube drainage volume at 6 and 24 hours was significantly greater in the patients with MA ≤50 mm (476.90 ± 156.36 mL v 403.36 ± 133.24 mL; p < 0.001 and 935.86 ± 318.43 mL v 667.21 ± 222.75 mL; p < 0.001, respectively). The consumption of blood products in patients with MA ≤50 mm was significantly more than those with MA >50 mm. The durations of intensive care unit stay and length of postoperative hospital stay were markedly longer in the MA ≤50 group than in the MA >50 group (p = 0.001 and p = 0.005; respectively). There were no significant differences in adverse outcomes between the 2 groups except for the postoperative atrial fibrillation, which occurred more in the MA ≤50 group than in the MA >50 group (8.05% v 1.77%; p = 0.043). MA (area under the receiver operating characteristic curve of 0.767; p < 0.001) was demonstrated to have significant ability to predict bleeding tendency, with a sensitivity of 76.2% and a specificity of 69.0%.

CONCLUSIONS

Preoperative MA may play a potential role in the prediction of postoperative bleeding and allogeneic blood transfusions and guide clinicians in perioperative management of patients undergoing CABG with CPB.