Changes in function of platelet after total aortic arch replacement and their influencing factors

Chen Liang; Yao Jing-xin; Lv Lin; Long Cun; Lou Song

doi:10.13498/j.cnki.chin.j.ecc.2017.03.03

Abstract：Objective To evaluate the platelet function and blood coagulation of patients received thoracic aortic procedures with deep hypothermic circulatory arrest (DHCA),and to investigate their influencing factors.Methods The study consisted of 50 patients scheduled for aorta replacement undergoing DHCA between June 2014 and March 2015.Patients with re-operation,prescription antiplatelet drugs within 7 days before operation,onset time over 30 days and hematological diseases were excluded.Function of platelet and coagulation were tested by thrombelastogram (TEG) at two intervals,namely after anesthesia induction (T1) and 5 mins after protamine neutralization (T2).Blood routine examination and coagulating time test were also included.Results Compared with before cardiopulmonary bypass (CPB),MA value and fibrinogen (FIB) significantly reduced on T2 (P<0.001,P<0.001).Platelet count and hemoglobin concentration were both statistically decreased after protamine neutralization(P<0.001,P<0.001).There was a liner relationship between platelet function and platelet count before CPB (r=0.76,P=0.008).The correlation between function of platelet before operation and onset time was quadratic curve relationship (R2=0.551,P<0.001).Multivariate logistic regression analysis revealed that female (OR=0.097,P=0.047) and body mass index (OR=1.197,P=0.036) were risk factors associated with platelet transfusion at the end of CPB,while the function of platelet (OR=0.852,P=0.026) before surgery was a protective factor.The area under the ROC curve of MA before surgery on platelet transfusion was 0.843 (95％CI: 0.660-1.000,P=0.004).The specificity of MA<59.95mm was 75％,the sensitivity was 93％.Conclusion The levels of FIB and platelet function significantly decreased at the end of CPB,while most of patients'' platelet functions were at normal range.Blood platelet transfusion might be more reasonable for patients of female,lower BMI and MA <59.95mm before surgery.