Association of Adenosine Diphosphate-Induced Platelet Maximum Amplitude With Postoperative Bleeding and Blood Transfusions in Patients Undergoing Coronary Artery Bypass Grafting

Objectives: To investigate the association of adenosine diphosphate (ADP)-induced platelet maximum amplitude (MA_ADP) with postoperative bleeding and blood product transfusions in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

Design: This single-center observational study recruited 200 patients who underwent elective, first-time, isolated CABG with CPB. A rapid thromboelastography with platelet mapping test was conducted for all patients before the surgery. Patients were categorized by the preoperative MA_ADP into ≤50 mm (MA_ADP ≤50 group [n = 87]) and MA_ADP >50 mm (MA_ADP >50 group [n = 113]). The primary outcome was postoperative bleeding at 6 and 24 hours as measured by chest tube drainage volume. The perioperative blood product transfusions, postoperative complications, postoperative time course, and in-hospital mortality also were evaluated.

Setting: University hospital.

Participants: Adult patients scheduled to undergo isolated primary CABG with CPB.

Interventions: None.

Measurements and main results: The study included 200 patients who underwent CABG with CPB. MA_ADP was >50 mm in 113 (56.5%) patients (MA_ADP >50 group). Compared with the MA_ADP >50 group, the postoperative chest tube drainage volume at 6 and 24 hours was significantly greater in the patients with MA_ADP ≤50 mm (476.90 ± 156.36 mL v 403.36 ± 133.24 mL; p < 0.001 and 935.86 ± 318.43 mL v 667.21 ± 222.75 mL; p < 0.001, respectively). The consumption of blood products in patients with MA_ADP ≤50 mm was significantly more than those with MA_ADP >50 mm. The durations of intensive care unit stay and length of postoperative hospital stay were markedly longer in the MA_ADP ≤50 group than in the MA_ADP >50 group (p = 0.001 and p = 0.005; respectively). There were no significant differences in adverse outcomes between the 2 groups except for the postoperative atrial fibrillation, which occurred more in the MA_ADP ≤50 group than in the MA_ADP >50 group (8.05% v 1.77%; p = 0.043). MA_ADP (area under the receiver operating characteristic curve of 0.767; p < 0.001) was demonstrated to have significant ability to predict bleeding tendency, with a sensitivity of 76.2% and a specificity of 69.0%.

Conclusions: Preoperative MA_ADP may play a potential role in the prediction of postoperative bleeding and allogeneic blood transfusions and guide clinicians in perioperative management of patients undergoing CABG with CPB.

Keywords: Thromboelastography; bleeding; coronary artery bypass grafting; platelet mapping.