Bibliographic Details
| Title: |
THE SIGNIFICANCE OF IMPEDANCE AGGREGOMETRY IN CARDIAC SURGERY. |
| Alternate Title: |
ZNAČAJ IMPEDANTNE AGREGOMETRIJE U KARDIOHIRURGIJI. |
| Authors: |
Milić, Dragan1,2 drdraganmilic@gmail.com, Lazarević, Milan1,2, Golubović, Mladjan1,2, Perić, Velimir1,2, Kamenov, Aleksandar1,2, Stojiljković, Vladimir1,2, Stošić, Marija1,2, Živić, Saša2, Milić, Isidora1, Spasić, Dimitrije2 |
| Source: |
Acta Medica Medianae. Mar2024, Vol. 63 Issue 1, p5-13. 9p. |
| Subject Terms: |
*BLOOD platelet aggregation, *CARDIAC surgery, *BLOOD platelet transfusion, *VON Willebrand factor, *ADENOSINE diphosphate, *BLOOD platelet activation |
| Abstract (English): |
The function of normal hemostasis is to prevent blood loss from an uninjured blood vessel and to stop excessive bleeding from a damaged blood vessel. Blood loss from an uninjured vessel is prevented by normal vessel structure and normal platelet function. Platelet aggregation is mediated by von Willebrand factor, a polymeric plasma glycoprotein. This protein binds to specific platelet membrane receptors and collagen. Primary aggregation of incoming platelets is facilitated by the action of thrombin. Aggregated platelets then release serotonin, thromboxane A2 and adenosine diphosphate (ADP) which stimulate vasoconstriction which is an additional stimulus for platelet aggregation and represents secondary aggregation. Many factors are related to bleeding during cardiac surgical procedures. Impedance aggregometry is a test of aggregation of platelets in whole blood, which allows us to observe the function of platelets in the presence of erythrocytes and leukocytes and prevents the artificial activation of platelets that occurs due to the separation process. Aggregometry is used to diagnose disorders of platelet function, which are rarely congenital, and most often acquired. In our research, we proved that 31% of patients had post-operatively impaired platelet function, with postoperative bleeding after 24 hours being statistically significantly higher in patients with ADP < 300 AU/min 24 hours after surgery, as well as TRAP < 500 AU/min 24 hours after surgery (p = 0.002). Twenty-two patients (22.0%) received a platelet transfusion 3 hours after surgery - ADP test ≤ 300 AU/min, ASPI ≤ 400 AU/min, TRAP ≤ 500 AU/min. On average, 11.14 ± 4.45 doses were administered. No patient in this study needed a transfusion of platelets 24 h after the procedure. Contemporary principles such as “time is life” together with modern clinical protocols and experienced personnel are essential in the treatment of hemostatic disorders during cardiac interventions. [ABSTRACT FROM AUTHOR] |
| Abstract (Croatian): |
Hemostaza je složen biološki proces kojim se sprečava gubitak krvi iz neoštećenog krvnog suda, kao i prekomerni gubitak cirkulišuće krvi kod povređenog krvnog suda. Za normalno funkcionisanje hemostaze neophodno je da krvni sud ima histološki normalnu građu zida, kao da je i funkcija trombocita očuvana. Von Willebrandov faktor predstavlja ključni činilac agregacije trombocita. Ovaj glikoprotein plazme vezuje se za receptore trombocita i kolagen. Trombin olakšava primarnu agregaciju prisutnih trombocita, koji nakon toga oslobađaju adenozin-difosfat (ADP), tromboksan A2 i serotonin; svi oni zajedno izazivaju posledičnu vazokonstrikciju, koja dovodi do sekundarne agregacije trombocita. Krvarenje nakon aortokoronarnog bajpasa posledica je delovanja brojnih faktora. Test agregacije trombocita u celoj krvi (impedantna agregometrija) omogućava analizu funkcije trombocita u prisustvu leukocita i eritrocita. Ova metoda se koristi za dijagnostikovanje oštećene funkcije trombocita, koja je uglavnom stečenog, a izuzetno retko urođenog karaktera. Naše istraživanje pokazalo је da je 31% bolesnika imao postoperativno poremećenu funkciju trombocita, s tim što je postoperativno krvarenje posle 24 sata bilo statistički značajno veće kod bolesnika sa vrednostima ADP < 300 AU/min 24 sata nakon operacije, kao i TRAP < 500 AU/min 24 sata posle operacije (p = 0,002). Tri sata nakon operacije, transfuziju trombocita primila su 22 bolesnika (22,0%): ADP test ≤ 300 AU/min, ASPI ≤ 400 AU/min, TRAP ≤ 500 AU/min. Prosečno je davano 11,14 ± 4,45 doza. Dvadeset četiri časa nakon intervencije nije bilo bolesnika kojima je bila potrebna transfuzija koncentrata trombocita. Upotreba savremenih metoda, u kombinaciji sa dokazanim kliničkim protokolima i velikim kliničkim iskustvom osoblja i uz poštovanje principa „vreme je život”, omogućava najbolje moguće zbrinjavanje bolesnika sa detektovanim poremećajem hemostaze u kardiohirurgiji. [ABSTRACT FROM AUTHOR] |
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