Yoshikawa Yusuke, Maeda Makishi, Ohno Sho, Takahashi Kanako, Sawashita Yasuaki, Hirahata Tomoki, Iba Yutaka, Kawaharada Nobuyoshi, Edanaga Mitsutaka, Yamakage Michiaki
Department of Anaesthesiology, Sapporo Medical University, Sapporo, JPN.
Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN.
Cureus. 2023 Apr 24;15(4):e38044. doi: 10.7759/cureus.38044. eCollection 2023 Apr.
Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitudein the kaolin with heparinase (HKH) assay (MA) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. Methods We included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MA and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. Results In 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MA (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. Conclusion These findings suggest that not only MAbut also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.
背景 本回顾性观察性研究的目的是探索在心血管手术（包括体外循环（CPB）期）中，血栓弹力图仪（TEG）6s血小板功能分析的高岭土加肝素酶（HKH）检测法（MA）中最大振幅的早期预测参数。还评估了该检测法的各参数与实验室数据之间的关系。方法 我们纳入了2021年11月至2022年5月期间在CPB下进行心血管手术时接受TEG 6s血小板功能分析的患者。评估了MA与早期参数之间的相关性。还通过受试者工作特征（ROC）曲线评估了血小板功能分析的各参数与纤维蛋白原浓度>150 mg/dL和血小板计数>100,000/µL的组合之间的关联。结果 在研究期间接受TEG 6s血小板功能分析的23例患者中，分析了62份HKH检测数据，包括59对数据（HKH检测数据和实验室数据）。K值和角度与MA显著相关，但R值不相关（r [95% CI]：K值为-0.90 [-0.94, -0.83]，p < 0.0001；角度为0.87 [0.79, 0.92]，p < 0.0001）。此外，ROC曲线表明这些参数能高精度地预测纤维蛋白原浓度>150 mg/dL和血小板计数>100,000/µL的组合。在CPB期间获得的肝素化血样中也证实了类似结果。结论 这些发现表明，不仅MA，而且HKH检测法中的早期参数K值和角度，都能提供具有临床意义的信息，有助于在包括CPB期在内的心血管手术期间快速做出关于凝血策略的决策。
