Platelet function changes as monitored by cone and plate(let) analyzer during beating heart surgery

Background: Off-pump coronary artery bypass (OPCAB) is believed to reduce cardiopulmonary bypass (CPB)-related complications, including platelet damage. A hypercoagulable state instead of coagulopathy has been reported following OPCAB surgeries due to CPB. Whether platelet function is changed when the injurious effect of CPB is eliminated was investigated. Methods: Platelet function was determined with the cone and plate(let) analyzer (CPA) method. The 2 parameters, average size (AS) and surface coverage (SC) of platelet aggregates, were measured with the CPA method to assess platelet aggregation and adhesion. These parameters were evaluated, and their values were compared at several stages of OPCAB surgery. The correlations of postoperative bleeding with platelet function at different stages of the surgery and with other factors, such as platelet count, hematocrit, and transfusions, were studied. Results: Both AS and SC increased during several stages of the operation, and postoperative values (mean +/- SD) were significantly higher than preoperative values (30.4 +/- 8.1 mum(2) versus 23.3 +/- 6.9 mum(2) for AS [P = .02] and 7.6% +/- 3.6% versus 5.2% +/- 1.8% for SC [P = .04]). The mean total bleeding volume was 875 +/- 415 mL. Preoperative AS and SC were the only parameters significantly (P = .01) and linearly (r = 0.7) related to postoperative bleeding. Conclusions: An increased platelet function, as determined by the CPA method, is found following OPCAB surgery. This phenomenon is probably at least partially responsible for the thrombogenic state after OPCAB surgery. Lack of platelet injury attributed to CPB may divert the system toward a more thrombogenic state. Preoperative platelet function, as evaluated by the CPA method, is an independent risk factor determining postoperative bleeding.