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Platelet function in paediatric patients undergoing surgery for cyanotic congenital heart defects
Author(s) -
Rivo J.,
Gozal Y.,
Raushenbach M.,
Varon D.,
Katz J.
Publication year - 2006
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2006.02119_2.x
Subject(s) - medicine , cardiopulmonary bypass , ristocetin , platelet , epinephrine , cardiac surgery , heparin , protamine , venous blood , anesthesia , adenosine diphosphate , cardiology , coagulation , gastroenterology , surgery , von willebrand factor , platelet aggregation
Coagulation abnormalities accompany cardiac surgery in children with cyanotic congenital heart defects (CHD). However the state of primary haemostasis in such patients remains insufficiently investigated. Methods: This study conforms to the principles of the Declaration of Helsinki. Nineteen pediatric patients aged 7 days–10 years with cyanotic CHD undergoing correction surgery were enrolled in the study. Citrated venous blood was taken at three points – prior to operation, after termination of cardiopulmonary bypass and neutralization of heparin by protamine and on postoperative day two. Optical platelet aggregometry with adenosine diphosphate, epinephrine, collagen and ristocetin as platelets agonists was used. The results were calculated statistically using Student's t ‐test. Results: Our results demonstrate that ADP‐induced platelet aggregation was markedly reduced after operation (73.2 ± 19 vs 43.2 ± 24.9; P < 0.005). Similar results were obtained for epinephrine (56.7 ± 28.9 vs 31 ± 29.4; P < 0.05) and ristocetin‐induced platelet aggregation (90.3 ± 25.6 vs 59 ± 21.4; P < 0.001), whereas the effect of collagen had a trend to decrease remaining however statistically insignificant (53.6 ± 40.4 vs 31.2 ± 34.3; P < 0.2). Both haemoglobin and haematocrit levels remained unchanged, whereas platelet count dramatically decreased (from 339.4 ± 159.4 to 138.9 ± 80.3; P < 0.001) that can potentially be explained by platelet destruction during cardiopulmonary bypass. On the second postoperative day, the amount of platelets remained unchanged (180.8 ± 102.0; P > 0.5) whereas platelet aggregation returned to the initial values (77.1 ± 14.2, 73.6 ± 17.1 and 81.0 ± 12.8 for ADP, epinephrine and ristocetin‐induced aggregation, respectively; in all cases P > 0.1 compared with the level before operation). Haemoglobin and haematorcrit levels were similar after operation and on the second day. Discussion: As stated in the results section, platelet aggregation recovers on the second postoperative day whereas platelet count remains relatively low. Consequently, changes in platelet aggregation observed immediately after operation cannot be explained only by the decrease in platelet count. Conclusions: (i) Platelet aggregation induced by different agonists, as well as platelet count, decrease in children with cyanotic CHD immediately after operation; and (ii) platelet aggregation but not platelet count recovers on the second postoperative day.