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Preoperative Measurement of Platelet Contribution to Clot Stiffness (PCS) with the Quantra® QPlus® System and Bleeding after Cardiac Surgery

1Huntsville Hospital, Huntsville, United States, 2HemoSonics LLC, Charlottesville, United States

Abstract Number: LPB0107

Meeting: ISTH 2021 Congress

Theme: Diagnostics and OMICs » Laboratory Diagnostics

Background: PCS estimated by the Quantra QPlus System is associated with platelet count and ADP-dependent platelet function (1). It has been shown that preoperative ADP-dependent platelet function could predict post-operative bleeding in cardiac surgery and guides waiting time in clopidogrel-treated patients (2,3). The association of preoperative PCS with postoperative blood loss is unknown.

  1. Baryshnikova E, et al. J Cardiothorac Vasc Anesth. 2019;33:1590-8.
  2. Ranucci M, et al. Br J Anaesth. 2014;113:970-6.
  3. Mahla E, et al. Circ Cardiovasc Interv. 2012;5:261-9. 

Aims: Assessment of the correlation of preoperative PCS with platelet count and ADP-dependent platelet function and its association with postoperative blood loss in adult patients undergoing cardiac surgery.

Methods: Prospective observational study in 40 patients (34 male; mean age 64 years) on platelet P2Y12-inhibitors undergoing cardiac surgery (38 CABG, 2 other). Preoperative whole blood samples were tested for platelet count, PCS (hPa) and ADP-dependent platelet function (TEG Platelet Mapping (TEG-PM): MA-ADP(mm) and % ADP-inhibition; Verify Now PRU Test). Blood loss was measured by drain output with severe blood loss defined as > 1000 mL at 24 hours. Correlation between parameters was assessed by the Pearson correlation coefficient. Association with severe blood loss was assessed by receiver operating curve (ROC) analysis.

Results:

Parameter  AUC (95% CI) P-value
PCS (hPa) 0.78 (0.62-0.89) 0.0002
TEG-PM; MA-ADP (mm) 0.72 (0.55-0.85) 0.0117
TEG-PM; %ADP-Inhibition  0.66 (0.49-0.80) 0.0729
VerifNow PRU 0.58 (0.41-0.73) 0.4166

ROC analysis: preoperative platelet function parameters and severe blood loss (>1000 mL at 24 hours).
Mean (SD) 24-hour blood loss was 969 (406) mL, with 18 patients (45%) showing severe blood loss. PCS demonstrated a weak correlation with platelet count (r=0.42) and MA-ADP (r=0.46) and a negligible correlation with % ADP-inhibition (r=-0.21) and Verify Now PRU (r=0.29). Pre-surgical PCS and TEG-PM (MA-ADP) were significantly associated with severe blood loss at 1000 mL (Table 1).

Conclusions: Pre-surgical PCS, rapidly assessed by the whole blood Quantra QPlus System, can predict severe post-operative blood loss. Larger studies are needed to validate whether pre-surgical PCS can guide the waiting time for surgery for patients on P2Y12-inhibitors.

To cite this abstract in AMA style:

B Washburn Jr T, Houdijk W, Sudhagoni R. Preoperative Measurement of Platelet Contribution to Clot Stiffness (PCS) with the Quantra® QPlus® System and Bleeding after Cardiac Surgery [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/preoperative-measurement-of-platelet-contribution-to-clot-stiffness-pcs-with-the-quantra-qplus-system-and-bleeding-after-cardiac-surgery/. Accessed September 22, 2023.

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