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Dear Editor, Platelet Function Analyzer (PFA)-100 (Siemens, Erlangen, Germany) has been proposed for preoperative screening because it is simple, easy-to-use, and can evaluate both the adhesion and aggregation of platelets [1]. Recently, PFA-100 has been upgraded to PFA-200, but the principle and method are the same. Previous studies reported conflicting opinions on the association of PFA-100 (Siemens) with blood transfusion, but diseases and surgery types differed across studies [1-4]. Therefore, we examined the association between PFA-200 results and the frequency of perioperative blood transfusion across surgery types. We retrospectively analyzed the results of PFA-200 and other laboratory tests such as complete blood count (CBC), prothrombin time (PT), and activated partial thromboplastin time (aPTT) as well as transfusion records, medication history, and surgery types from 2,474 patients who underwent surgery with preoperative PFA-200 screening between January and December 2014. We excluded 477 patients with low hematocrit (<35%) or platelet counts (<150.0×10/L), as well as seven infants under one year old [5, 6]; thus, the final study group comprised 1,990 patients (Table 1). Surgery types were classified as major operations (e.g., gastrectomy, total hip arthroplasty, and cholecystectomy) and minor operations (e.g., tonsillectomy, percutaneous vertebroplasty, and tracheostomy). The study was approved by the Hallym University Sacred Heart Hospital Institutional Review Board (No. 2017-I045). The PFA-200 system consists of a reservoir, capillary, and cartridges containing collagen/epinephrine (CEPI) or collagen/adenosine diphosphate (CADP). Platelets in the blood are activated by CEPI or CADP, adhere, and aggregate to form a plug that gradually obstructs the capillary hole in the cartridge. The closure time (CT), measured in seconds, represents platelet function [7]. The reference ranges in our laboratory were 80–191 seconds and 62–119 seconds for CEPI and CADP, respectively. We categorized patients as “prolonged CT” if CEPI-CT or CADPCT was longer than the reference ranges and as “normal CT” if both were within the reference ranges. The statistical analysis was performed using SPSS Statistics for Windows, version 24 (IBM Corp., Armonk, NY, USA). The Mann–Whitney U test was used to compare continuous variables. The chi-square test or Fisher’s exact test was used to compare the frequency of blood transfusion between groups. The association between prolonged CT and the frequency of blood transfusion was evaluated using logistic regression. P <0.05 was con-

Association Between Prolonged Closure Time on the Platelet Function Analyzer-200 and Risk of Perioperative Blood Transfusion