Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

Abstract

Individual variability in the response to antiplatelet therapy (APT), frequently administered preoperatively, has been established by various platelet function assays and could reflect bleeding tendency after coronary artery bypass surgery (CABG). Our hypothesis is that multiple electrode whole-blood aggregometry (MEA) can identify patients at risk for excessive bleeding. We enrolled 211 patients (155 male and 56 female) undergoing isolated CABG in a prospective observational study. Patients were divided into four groups with respect to their preoperative APT management. MEA, using the ASPI and the ADP test, was performed prior to surgery. The primary endpoint was chest tube output (CTO) and the secondary endpoint was perioperative packed red blood cell concentrate (PRBC) administration. Patients were characterized as bleeders if their 24h CTO exceeded the 75th percentile of distribution. 24h CTO value of 11.33ml/kg presented 75th percentile of distribution, thus cut-off value for "bleeder category". The proportion of patients characterized as bleeders was significantly different among the groups in regard to preoperative APT (p=0.039). Significant differences in both ASPI (p<0.001) and ADP (p=0.038) tests were observed between different preoperative APT groups. Significant correlations between the ASPI test (r=-0.170, p=0.014) and ADP test (r=-0.206, p=0.003) with 24h CTO were found. The receiver operating curve revealed an ASPI test value of <20 area under curve (AUC) units (AUC 0.603, p=0.023) and an ADP test <73 AUC (AUC 0.611, p=0.009) as a "bleeder" determinant. The proportion of patients transfused with PRBC did not significantly differ among the groups in regard to preoperative APT (p=0.636). Comparison of the ASPI test values between patients with respect to PRBC administration revealed lower values in the ASPI test in a group of patients transfused with PRBC (mean, 27.88 vs. 40.32 AUC, p=0.002). Our study showed that MEA is a useful method of predicting CABG patients with excessive postoperative bleeding.