Abstract
Hemostasis is crucial for reducing bleeding during surgical procedures. The points-of-care based on the platelet function test could be useful to minimize the complications related to chronic antiplatelet therapy during surgery. The present study is aimed at comparing two point-of-care platelet function devices—Platelet Function Analyzer PFA-100® (Siemens Canada, Mississauga, ON, Canada) and Plateletworks®(Helena Laboratories, Beaumont, TX, USA). Our objective is to evaluate if they provide comparable and useful information to manage anti-aggregate patients before surgery. We included patients with a femoral fracture receiving chronic antiplatelet therapy and a median age of 89 years (range from 70 to 98). A platelet function evaluation was performed on all patients before surgery using both devices—Plateletworks® and PFA-100®. The correlation between Plateletworks® and PFA-100® was performed using Cohen’s Kappa coefficient. Twenty consecutive patients participated in the trial; 16 patients were under treatment with 75 mg/day of clopidogrel, three with >300 mg/day of acetylsalicylic acid (ASA), and only one was in treatment with both antiplatelet agents. Cohen’s Kappa coefficient was 0.327 comparing PFA-100®-ADP (adenosine diphosphate) and Plateletworks® and, 0.200 comparing PFA-100®-EPI (epinephrine) and Plateletworks®. In conclusion, we found a weak concordance comparing PFA-100® and Plateletworks®. This could partially be due to the advanced age of the included patients. However, given the limited sample size, more studies are necessary to confirm these results.
Highlights
The principal outcome of this trial is to assess if the strategy of measuring preoperative platelet function in patients with chronic antiplatelet drugs can reduce the time from hospital admission to operation under spinal anesthesia and whether it affords any benefits in comparison with the usual approach centered on postponing surgery and stopping antiplatelet drug therapy
We only considered the first determination of platelet function for all patients
Our study showed a weak correlation between PFA-100® and Plateletworks® for measuring platelet function
Summary
Hemostasis is crucial for reducing bleeding and wound healing. It can be altered for different causes, such as platelet stimulation, deficiency of receptors for fibrinogen (Gp IIb IIIa ) and von Willebrand factor (Gp Ib ), and decreased platelet aggregation secondary to administration of heparin, as well as the presence of platelet dilution [1]. It has been demonstrated that the use of antiplatelet therapy has been associated with postoperative bleeding [3] For this reason, the preoperative quantification of platelet function is proposed in a few guidelines [4] to know whether the patients presenting for surgery have platelet inhibition or not
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