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Bleeding Risk Assessment Using Multiple Electrode Aggregometry in Patients Undergoing Coronary Artery Bypass Surgery. A Single-center Study
Sergey Altarev, Cristina Krivoshapova, Tatiana Penskaya, Olga Gruzdeva, Georgiy Plotnikov, Egor Malyshenko, Sergey Ivanov, Olga Barbarash.
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
OBJECTIVE: Individual variability in platelet function assessed by various assays has been established and could be associated with bleeding complications after coronary artery bypass surgery (CABG). Our hypothesis is that multiple electrode whole-blood aggregometry (MEA) can help identify patients at risk for high/excessive bleeding.
METHODS: We retrospectively analyzed data of the patients undergone CABG in 2011 to 2013 in whom we performed MEA in the preoperative period. On-pump or off-pump CABG under standard protocols of our institution was applied to all patients and done by our hospital’s routine staff surgery teams. Chest-tube output was calculated using the amount in milliliters collected from the chest-tube draining the surgical site during the immediate 6-, 12-, and 24-hour postoperative period.
The database was formed in Microsoft Office Excel 2007 (Microsoft Corporation, USA). The statistical analysis was done with statistical software package SPSS for Windows, version 13.0 (SPSS Inc., USA). Relationships between 2 numerical variables were calculated with a linear regression analysis. Factors independently associated with excessive 24-hour drainage loss were determined with discriminant analysis. A ROC curve was used to see a validity of the model. All the p values described are 2-sided and a p<0.05 was considered statistically significant.
RESULTS: We analyzed data of 160 patients (127 (79.4%) males) with mean age 61.4±7.3 yrs. Most of the surgeries were done for a stable angina with only 5 patients (3.3%) having acute coronary syndrome. In 138 cases (92.0%), CPB was used.
Significant correlations between ADP dependent platelet aggregation and 6- and 12-hour drainage loss were found with every 1% decrease in the ADP dependent platelet aggregation, drainage loss increased by 1.3 (p=0.001) and 2.0 ml (p=0.003), respectively.
The discriminant analysis revealed that among all the different MEA test only ADP dependent platelet aggregation was independently associated with high/excessive 24-hour drainage loss (F=5.9, p=0.02), and the final model was:
Z=-3.74+0.05*ADP test, AUC 0.78 (95% confidence interval 0.53 to 1.03, p=0.06).
The model allowed 80.8% cases to be correctly classified in respect to 24-hour drainage loss.
CONCLUSIONS: Our study showed that MEA is a useful method of predicting high/excessive post-CABG bleeding.
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