Thromboelastograph with platelet mappingTM predicts postoperative chest tube drainage in patients undergoing coronary artery bypass grafting

Mohsin Chowdhury, Linda Shore-Lesserson, Alec M. Mais, Galina Leyvi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PMTM) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). Design A retrospective analysis. Association between predictor variables (MA ADP [maximum amplitude produced by adenosine diphosphate], MA AA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was≥600 mL within 12 hours after surgery. Setting A university hospital. Participants Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PMTM done as a point-of-care test. Interventions None. Results A total of 78 patients had preoperative TEG-PMTM test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). Conclusions TEG-PMTM parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively.

Original languageEnglish (US)
Pages (from-to)217-223
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume28
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Chest Tubes
clopidogrel
Coronary Artery Bypass
Drainage
Blood Platelets
Platelet Transfusion
Odds Ratio
Body Mass Index
Adenosine Diphosphate
Logistic Models
Point-of-Care Systems
Arachidonic Acid
Blood Transfusion
Aspirin
Hemorrhage
Therapeutics

Keywords

  • anti-platelet therapy
  • CABG
  • platelet mapping
  • thromboelastography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Thromboelastograph with platelet mappingTM predicts postoperative chest tube drainage in patients undergoing coronary artery bypass grafting. / Chowdhury, Mohsin; Shore-Lesserson, Linda; Mais, Alec M.; Leyvi, Galina.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 28, No. 2, 2014, p. 217-223.

Research output: Contribution to journalArticle

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abstract = "Objective The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PMTM) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). Design A retrospective analysis. Association between predictor variables (MA ADP [maximum amplitude produced by adenosine diphosphate], MA AA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was≥600 mL within 12 hours after surgery. Setting A university hospital. Participants Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PMTM done as a point-of-care test. Interventions None. Results A total of 78 patients had preoperative TEG-PMTM test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6{\%}) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). Conclusions TEG-PMTM parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6{\%} whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22{\%} and 23{\%} respectively.",
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N2 - Objective The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PMTM) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). Design A retrospective analysis. Association between predictor variables (MA ADP [maximum amplitude produced by adenosine diphosphate], MA AA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was≥600 mL within 12 hours after surgery. Setting A university hospital. Participants Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PMTM done as a point-of-care test. Interventions None. Results A total of 78 patients had preoperative TEG-PMTM test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). Conclusions TEG-PMTM parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively.

AB - Objective The goal of this study was to evaluate the ability of Thromboelastograph with Platelet Mapping (TEG-PMTM) to predict postoperative bleeding tendency in patients with a history of recent anti-platelet therapy undergoing coronary artery bypass grafting (CABG). Design A retrospective analysis. Association between predictor variables (MA ADP [maximum amplitude produced by adenosine diphosphate], MA AA [maximum amplitude produced by arachidonic acid], percent of platelets inhibited by clopidogrel, percent of platelets inhibited by aspirin) and the outcomes as elevated chest tube drainage (CTD) and blood transfusion were investigated by logistic regression model. CTD was considered elevated if it was≥600 mL within 12 hours after surgery. Setting A university hospital. Participants Patients on antiplatelet therapy scheduled to undergo CABG that had TEG-PMTM done as a point-of-care test. Interventions None. Results A total of 78 patients had preoperative TEG-PMTM test and on-pump CABG surgeries performed on the same day. Among them, 20 patients (25.6%) had elevated CTD. Decreased MAADP (odds ratio [OR] 0.94), increased percent inhibition of platelets by clopidogrel (OR 1.03), and lower body mass index (BMI) (OR 0.78) were significantly associated with elevated CTD. The same parameters were also associated with platelets transfusion: MAADP (OR 0.94), percent of inhibition of platelets by clopidogrel (OR 1.03) and BMI (OR 0.77). Conclusions TEG-PMTM parameters and BMI are predictive of elevated CTD and platelets transfusion. A 1 mm decrease in MAADP increases the likelihood of elevated CTD and the likelihood of platelets transfusion by 6% whereas 1 unit decrease in BMI is associated with an increased likelihood of elevated CTD and platelets transfusion by 22% and 23% respectively.

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KW - thromboelastography

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