Sonorheometry assessment of platelet function in cardiopulmonary bypass patients

Correlation of blood clot stiffness with platelet integrin αiIbβ3 activity, aspirin usage, and transfusion risk

Francesco Viola, Xiefan Lin-Schmidt, Castigliano Bhamidipati, Doris M. Haverstick, William F. Walker, Gorav Ailawadi, Michael B. Lawrence

Research output: Contribution to journalArticle

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Abstract

Background Impaired platelet function may underlie bleeding associated with cardiopulmonary bypass (CPB) and at present is incompletely evaluated with existing diagnostic technologies. Sonorheometry (SR) is a recently developed ultrasound-based technology that quantifies hemostasis and platelet activity from a blood sample by measuring ex vivo clot stiffness (S). We hypothesized that impaired platelet-fibrin interactions as assessed by SR would correlate with transfusion during CPB and history of prior aspirin therapy. Methods Thirty-nine patients undergoing elective cardiopulmonary bypass (CPB) were enrolled following informed consent (University of Virginia IRB#14050) in a prospective observational pilot study to assess pre-operative platelet function and transfusion frequency. To assess platelet activity, abciximab was added to blood prior to SR and native S versus abciximab treated S created a differential test for platelet activity. Patient blood samples were activated with kaolin and SR was then used to measure clot stiffness. Patients were transfused with blood products as directed by clinical practice, with the surgical team blinded to SR results. Results Blood clot stiffness with and without abciximab, was compared in a ratio test (S/Sabciximab) named the Platelet Function Index (PFI). PFI was hypothesized to be positively correlated with platelet contributions through integrin αIIbβ3 to clot stiffness. PFI for CPB subjects was lower for those receiving transfusions than those not receiving transfusions (p < 0.006). A receiver-operator characteristics (ROC) analysis correlating the PFI with the blinded surgical team's decision on transfusions that included platelet concentrates generated an area under the curve (AUC) of 0.79 (p < 0.001). Additionally, the mean value of PFI for subjects on aspirin therapy was lower than for those not on aspirin therapy (p < 0.02) and correlated with a 1.73-fold enhanced risk of receiving a peri-operative transfusion. Conclusion Evaluation of platelet function with SR may help in the specification of blood transfusion needs in cardiac surgery and in the assessment of aspirin effects on risk of surgical bleeding.

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
JournalThrombosis Research
Volume138
DOIs
StatePublished - Jul 22 2015
Externally publishedYes

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Cardiopulmonary Bypass
Integrins
Aspirin
Thrombosis
Blood Platelets
Platelet Transfusion
Hemorrhage
Technology
Kaolin
Research Ethics Committees
Hemostasis
Fibrin
Informed Consent
Blood Transfusion
Thoracic Surgery
Area Under Curve
Observational Studies
Therapeutics

ASJC Scopus subject areas

  • Hematology

Cite this

Sonorheometry assessment of platelet function in cardiopulmonary bypass patients : Correlation of blood clot stiffness with platelet integrin αiIbβ3 activity, aspirin usage, and transfusion risk. / Viola, Francesco; Lin-Schmidt, Xiefan; Bhamidipati, Castigliano; Haverstick, Doris M.; Walker, William F.; Ailawadi, Gorav; Lawrence, Michael B.

In: Thrombosis Research, Vol. 138, 22.07.2015, p. 96-102.

Research output: Contribution to journalArticle

Viola, Francesco ; Lin-Schmidt, Xiefan ; Bhamidipati, Castigliano ; Haverstick, Doris M. ; Walker, William F. ; Ailawadi, Gorav ; Lawrence, Michael B. / Sonorheometry assessment of platelet function in cardiopulmonary bypass patients : Correlation of blood clot stiffness with platelet integrin αiIbβ3 activity, aspirin usage, and transfusion risk. In: Thrombosis Research. 2015 ; Vol. 138. pp. 96-102.
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abstract = "Background Impaired platelet function may underlie bleeding associated with cardiopulmonary bypass (CPB) and at present is incompletely evaluated with existing diagnostic technologies. Sonorheometry (SR) is a recently developed ultrasound-based technology that quantifies hemostasis and platelet activity from a blood sample by measuring ex vivo clot stiffness (S). We hypothesized that impaired platelet-fibrin interactions as assessed by SR would correlate with transfusion during CPB and history of prior aspirin therapy. Methods Thirty-nine patients undergoing elective cardiopulmonary bypass (CPB) were enrolled following informed consent (University of Virginia IRB#14050) in a prospective observational pilot study to assess pre-operative platelet function and transfusion frequency. To assess platelet activity, abciximab was added to blood prior to SR and native S versus abciximab treated S created a differential test for platelet activity. Patient blood samples were activated with kaolin and SR was then used to measure clot stiffness. Patients were transfused with blood products as directed by clinical practice, with the surgical team blinded to SR results. Results Blood clot stiffness with and without abciximab, was compared in a ratio test (S/Sabciximab) named the Platelet Function Index (PFI). PFI was hypothesized to be positively correlated with platelet contributions through integrin αIIbβ3 to clot stiffness. PFI for CPB subjects was lower for those receiving transfusions than those not receiving transfusions (p < 0.006). A receiver-operator characteristics (ROC) analysis correlating the PFI with the blinded surgical team's decision on transfusions that included platelet concentrates generated an area under the curve (AUC) of 0.79 (p < 0.001). Additionally, the mean value of PFI for subjects on aspirin therapy was lower than for those not on aspirin therapy (p < 0.02) and correlated with a 1.73-fold enhanced risk of receiving a peri-operative transfusion. Conclusion Evaluation of platelet function with SR may help in the specification of blood transfusion needs in cardiac surgery and in the assessment of aspirin effects on risk of surgical bleeding.",
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T2 - Correlation of blood clot stiffness with platelet integrin αiIbβ3 activity, aspirin usage, and transfusion risk

AU - Viola, Francesco

AU - Lin-Schmidt, Xiefan

AU - Bhamidipati, Castigliano

AU - Haverstick, Doris M.

AU - Walker, William F.

AU - Ailawadi, Gorav

AU - Lawrence, Michael B.

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N2 - Background Impaired platelet function may underlie bleeding associated with cardiopulmonary bypass (CPB) and at present is incompletely evaluated with existing diagnostic technologies. Sonorheometry (SR) is a recently developed ultrasound-based technology that quantifies hemostasis and platelet activity from a blood sample by measuring ex vivo clot stiffness (S). We hypothesized that impaired platelet-fibrin interactions as assessed by SR would correlate with transfusion during CPB and history of prior aspirin therapy. Methods Thirty-nine patients undergoing elective cardiopulmonary bypass (CPB) were enrolled following informed consent (University of Virginia IRB#14050) in a prospective observational pilot study to assess pre-operative platelet function and transfusion frequency. To assess platelet activity, abciximab was added to blood prior to SR and native S versus abciximab treated S created a differential test for platelet activity. Patient blood samples were activated with kaolin and SR was then used to measure clot stiffness. Patients were transfused with blood products as directed by clinical practice, with the surgical team blinded to SR results. Results Blood clot stiffness with and without abciximab, was compared in a ratio test (S/Sabciximab) named the Platelet Function Index (PFI). PFI was hypothesized to be positively correlated with platelet contributions through integrin αIIbβ3 to clot stiffness. PFI for CPB subjects was lower for those receiving transfusions than those not receiving transfusions (p < 0.006). A receiver-operator characteristics (ROC) analysis correlating the PFI with the blinded surgical team's decision on transfusions that included platelet concentrates generated an area under the curve (AUC) of 0.79 (p < 0.001). Additionally, the mean value of PFI for subjects on aspirin therapy was lower than for those not on aspirin therapy (p < 0.02) and correlated with a 1.73-fold enhanced risk of receiving a peri-operative transfusion. Conclusion Evaluation of platelet function with SR may help in the specification of blood transfusion needs in cardiac surgery and in the assessment of aspirin effects on risk of surgical bleeding.

AB - Background Impaired platelet function may underlie bleeding associated with cardiopulmonary bypass (CPB) and at present is incompletely evaluated with existing diagnostic technologies. Sonorheometry (SR) is a recently developed ultrasound-based technology that quantifies hemostasis and platelet activity from a blood sample by measuring ex vivo clot stiffness (S). We hypothesized that impaired platelet-fibrin interactions as assessed by SR would correlate with transfusion during CPB and history of prior aspirin therapy. Methods Thirty-nine patients undergoing elective cardiopulmonary bypass (CPB) were enrolled following informed consent (University of Virginia IRB#14050) in a prospective observational pilot study to assess pre-operative platelet function and transfusion frequency. To assess platelet activity, abciximab was added to blood prior to SR and native S versus abciximab treated S created a differential test for platelet activity. Patient blood samples were activated with kaolin and SR was then used to measure clot stiffness. Patients were transfused with blood products as directed by clinical practice, with the surgical team blinded to SR results. Results Blood clot stiffness with and without abciximab, was compared in a ratio test (S/Sabciximab) named the Platelet Function Index (PFI). PFI was hypothesized to be positively correlated with platelet contributions through integrin αIIbβ3 to clot stiffness. PFI for CPB subjects was lower for those receiving transfusions than those not receiving transfusions (p < 0.006). A receiver-operator characteristics (ROC) analysis correlating the PFI with the blinded surgical team's decision on transfusions that included platelet concentrates generated an area under the curve (AUC) of 0.79 (p < 0.001). Additionally, the mean value of PFI for subjects on aspirin therapy was lower than for those not on aspirin therapy (p < 0.02) and correlated with a 1.73-fold enhanced risk of receiving a peri-operative transfusion. Conclusion Evaluation of platelet function with SR may help in the specification of blood transfusion needs in cardiac surgery and in the assessment of aspirin effects on risk of surgical bleeding.

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