Intraoperative changes in platelet function in relation to moderate haemorrhage

Jonathan J Hetherington, Isobel Ford, G Patrick Ashcroft, Jan O Jansen

Research output: Contribution to journalArticle

2 Citations (Scopus)
4 Downloads (Pure)

Abstract

BACKGROUND: Haemorrhage is associated with haemostatic dysfunction. Previous studies have focused on coagulation factors, but platelet function plays an equally important role. The time course of alterations in platelet function in relation to injurious stimuli is not known.

AIM: To evaluate short-term, intra-operative changes in platelet function, by whole blood impedance aggregometry in patients undergoing hip arthroplasty. The primary outcome was platelet aggregation in response to adenosine diphosphate (ADP) stimulation. We also evaluated other agonists, and the feasibility of conducting platelet aggregometry measurement in the operating theatre.

METHODS: Patients undergoing primary cemented hip arthroplasty had six peri-operative arterial blood samples analysed at pre-set stages of the operation, using the Multiplate® Impedance Aggregometer. Four agonists were used: ADP, TRAP, Collagen and Arachidonic Acid.

RESULTS: There was a statistically significant change (p<0.05, ANOVA) in platelet response to ADP over the course of the operations. The trend demonstrated an initial decrease in responsiveness, followed by increased platelet responsiveness in the later stages. Other agonists (TRAP, COL, ASPItest) demonstrated a similar pattern of changes. Of 360 tests conducted, 12 (3.3%) had to be re-run due to poor intra-assay variability. Satisfactory values were obtained on the second attempt in all 12 samples.

CONCLUSION: Platelet function, as measured by impedance aggregometry, changes in response to a surgical stimulus involving blood loss. The clinical significance of these changes, and the potential of manipulating them for therapeutic purposes, remains to be elucidated.

Original languageEnglish
Pages (from-to)1198-1202
Number of pages5
JournalThrombosis Research
Volume135
Issue number6
Early online date10 Apr 2015
DOIs
Publication statusPublished - Jun 2015

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Blood Platelets
Hemorrhage
Electric Impedance
Adenosine Diphosphate
Arthroplasty
Hip
Blood Coagulation Factors
Hemostatics
Platelet Aggregation
Arachidonic Acid
Analysis of Variance
Collagen

Keywords

  • haemorrhage
  • platelet aggregation
  • platelet function tests
  • surgery

Cite this

Intraoperative changes in platelet function in relation to moderate haemorrhage. / Hetherington, Jonathan J; Ford, Isobel; Ashcroft, G Patrick; Jansen, Jan O.

In: Thrombosis Research, Vol. 135, No. 6, 06.2015, p. 1198-1202.

Research output: Contribution to journalArticle

Hetherington, Jonathan J ; Ford, Isobel ; Ashcroft, G Patrick ; Jansen, Jan O. / Intraoperative changes in platelet function in relation to moderate haemorrhage. In: Thrombosis Research. 2015 ; Vol. 135, No. 6. pp. 1198-1202.
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AU - Ashcroft, G Patrick

AU - Jansen, Jan O

N1 - Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved. Funding The study was funded by TENOVUS Scotland (G12/14). Jan Jansen is in receipt of salary support through the NHS Research Scotland (NRS) fellowship scheme. Acknowledgements The authors are extremely grateful for the expert assistance and contributions of Dr Neil Scott (Medical Statistician, University of Aberdeen), Win Culley (Research Nurse, Woodend Hospital), Dr Karen Cranfield (Consultant Anaesthetist), and Ms Sharon Wood, (Research Technician, Rowett Institute of Nutrition and Health) for fibrinogen measurement.

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N2 - BACKGROUND: Haemorrhage is associated with haemostatic dysfunction. Previous studies have focused on coagulation factors, but platelet function plays an equally important role. The time course of alterations in platelet function in relation to injurious stimuli is not known.AIM: To evaluate short-term, intra-operative changes in platelet function, by whole blood impedance aggregometry in patients undergoing hip arthroplasty. The primary outcome was platelet aggregation in response to adenosine diphosphate (ADP) stimulation. We also evaluated other agonists, and the feasibility of conducting platelet aggregometry measurement in the operating theatre.METHODS: Patients undergoing primary cemented hip arthroplasty had six peri-operative arterial blood samples analysed at pre-set stages of the operation, using the Multiplate® Impedance Aggregometer. Four agonists were used: ADP, TRAP, Collagen and Arachidonic Acid.RESULTS: There was a statistically significant change (p<0.05, ANOVA) in platelet response to ADP over the course of the operations. The trend demonstrated an initial decrease in responsiveness, followed by increased platelet responsiveness in the later stages. Other agonists (TRAP, COL, ASPItest) demonstrated a similar pattern of changes. Of 360 tests conducted, 12 (3.3%) had to be re-run due to poor intra-assay variability. Satisfactory values were obtained on the second attempt in all 12 samples.CONCLUSION: Platelet function, as measured by impedance aggregometry, changes in response to a surgical stimulus involving blood loss. The clinical significance of these changes, and the potential of manipulating them for therapeutic purposes, remains to be elucidated.

AB - BACKGROUND: Haemorrhage is associated with haemostatic dysfunction. Previous studies have focused on coagulation factors, but platelet function plays an equally important role. The time course of alterations in platelet function in relation to injurious stimuli is not known.AIM: To evaluate short-term, intra-operative changes in platelet function, by whole blood impedance aggregometry in patients undergoing hip arthroplasty. The primary outcome was platelet aggregation in response to adenosine diphosphate (ADP) stimulation. We also evaluated other agonists, and the feasibility of conducting platelet aggregometry measurement in the operating theatre.METHODS: Patients undergoing primary cemented hip arthroplasty had six peri-operative arterial blood samples analysed at pre-set stages of the operation, using the Multiplate® Impedance Aggregometer. Four agonists were used: ADP, TRAP, Collagen and Arachidonic Acid.RESULTS: There was a statistically significant change (p<0.05, ANOVA) in platelet response to ADP over the course of the operations. The trend demonstrated an initial decrease in responsiveness, followed by increased platelet responsiveness in the later stages. Other agonists (TRAP, COL, ASPItest) demonstrated a similar pattern of changes. Of 360 tests conducted, 12 (3.3%) had to be re-run due to poor intra-assay variability. Satisfactory values were obtained on the second attempt in all 12 samples.CONCLUSION: Platelet function, as measured by impedance aggregometry, changes in response to a surgical stimulus involving blood loss. The clinical significance of these changes, and the potential of manipulating them for therapeutic purposes, remains to be elucidated.

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KW - platelet function tests

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