Key result
Low platelet-fibrin clot strength and aggregation linked to ~3.4-fold higher risk of post-CABG massive bleeding.
Why the study?
Although stratifying clopidogrel-treated patients by preoperative TEG ADP-stimulated platelet mapping resulted in similar perioperative bleeding compared with clopidogrel-naive patients undergoing CABG, the determinants of massive bleeding in these patients were unknown.
Does pre-operative coagulation profiling and platelet function testing (TEG, LTA, and VerifyNow) identify patients at risk for massive bleeding in patients undergoing elective first-time on-pump CABG?
Observational (n=168)
Does pre-operative coagulation profiling and platelet function testing (TEG, LTA, and VerifyNow) identify patients at risk for massive bleeding in patients undergoing elective first-time on-pump CABG?
Effect estimate: 3.4-fold increased risk (95% CI 1.6-7.2)
p-value: p=0.002
In patients undergoing first-time on-pump CABG, combining preoperative measurements of low thrombin-induced platelet-fibrin clot strength and collagen-induced platelet aggregation is associated with a 3.4-fold increased risk of massive postoperative bleeding regardless of clopidogrel exposure.
Background Stratifying clopidogrel-treated patients based on preoperative thrombeleatography (TEG) ADP-stimulated platelet mapping of clopidogrel response resulted in similar perioperative bleeding as compared with clopidogrel naïve patients undergoing CABG. Determinants of massive bleeding in these patients are unknown. Methods The present study enrolled 168 patients (93 clopidogrel naïve patients and 75 clopidogrel treated patients) undergoing first time on-pump CABG, and measured pre-operative coagulation profiles and platelet function testing (TEG, LTA, and VerifyNow). Whether these parameters identified patients with massive bleeding (defined as = 1000 mL during the first 24h postoperatively) was analyzed. Results Regardless of the clopidogrel exposure, patients with massive bleeding (n=69, 41.1%) had lower thrombin-induced platelet-fibrin clot strength (TEG MATH) (62.9±8.0 vs. 66.3±7.1mm, p=0.006) and 4μg/ml collagen-induced platelet aggregation (LTA PACOL: 35.1±27.7% vs. 44.1±27.0%, p=0.041) compared to those without massive bleeding. In multivariate analysis, a combination of low MATH (≥65mm) and PACOL (≥34%) was associated with a 3.4-fold increased risk for massive bleeding (95% confidence interval, 1.6 to 7.2; p=0.002). Conclusions Among patients undergoing first time on-pump CABG, low thrombin-induced platelet-fibrin clot strength + collagen-induced platelet aggregation may increase the predictive value of post-CABG massive bleeding and can be incorporated in future investigations.
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Gurbel et al. (2012) conducted an observational in Elective coronary artery bypass grafting (CABG) (n=168). Preoperative low thrombin-induced platelet-fibrin clot strength (TEG MATH) combined with low collagen-induced platelet aggregation (LTA PACOL) vs. Without low MATH and PACOL was evaluated on Massive bleeding (defined as = 1000 mL during the first 24h postoperatively) (3.4-fold increased risk, 95% CI 1.6-7.2, p=0.002). Low thrombin-induced platelet-fibrin clot strength plus collagen-induced platelet aggregation was associated with a 3.4-fold increased risk of post-CABG massive bleeding (95% CI 1.6-7.2; p=0.002).
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