WHAT'S NEW

DISCUSSION GROUPS

ARTICLE WATCH

UPCOMING EVENTS

PUBLICATIONS

CONTACT US

REFERENCES

REGULATORY

TESTS

VENDORS

PROCEDURES

DEFINITIONS

CLINICAL TOPICS

LINKS

SUBWEBS

The Relation between the Platelet-activated Clotting Test (HemoSTATUS) and Blood Loss after Cardiopulmonary Bypass - Anesthesiology V 88, No 4, April 1998 (1998; 88:962-9)

Mark H. Ereth, M.D.

Assistant Professor of Anesthesiology.

Gregory A. Nuttall, M.D.

Assistant Professor of Anesthesiology.

Paula J. Santrach, M.D.

Assistant Professor of Laboratory Medicine and Pathology.

Jacinta T. Klindworth, B.A.

Special Project Associate.

William C. Oliver, Jr., M.D.

Assistant Professor of Anesthesiology.

Hartzell V. Schaff, M.D.

Professor of Surgery.

  Background: Platelet dysfunction is one of several major causes of bleeding after cardiopulmonary bypass. A timely, simple, point-of-care determinant of platelet function recently became available for clinical use. Adding platelet-activating factor to conventional activated clotting time methods (platelet-activated clotting test [PACT]) produces rapid results (<15 min) and may yield a measure of platelet responsiveness and whole-blood procoagulant activity.

  Methods: Blood samples were drawn from 100 patients after cardiac surgery on their arrival in the intensive care unit for PACT, platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT). Cumulative blood loss at 4, 8, and 12 h after arrival in the intensive care unit and perioperative transfusion requirements were quantitated. Coagulation tests and mediastinal blood loss were compared using the Spearman rank test and Pearson correlation. The sensitivity and specificity of the laboratory tests for predicting blood loss were analyzed using the receiver operating characteristic method.

  Results: The PT was the only test that correlated with blood loss at 4, 8, and 12 h. The PACT did not correlate with blood loss at 4, 8, or 12 h, nor did the PACT correlate with the PT or the aPTT. The sensitivity and specificity of the PACT were less than those of the PT in predicting blood loss. Only the PT correlated with platelet and fresh frozen plasma transfusion.

  Conclusions: The PT correlated with blood loss and transfusion requirements and was superior to PACT, aPTT, and platelet count for predicting excessive blood loss after cardiopulmonary bypass. (Key words: Cardiac surgery; coagulation; laboratory analysis; monitoring; platelet function.)

Received from the Departments of Anesthesiology, Laboratory Medicine, and Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Submitted for publication May 1, 1997. Accepted for publication December 5, 1997. Supported by the Mayo Foundation for Medical Education and Research.

Address reprint requests to Dr. Ereth: Department of Anesthesiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905. Address electronic mail to: ereth.mark@mayo.edu

Anesthesiology
1998; 88:962-9
© 1998 American Society of Anesthesiologists, Inc.
Lippincott-Raven Publishers

Back to top