Algorithm-Based Platelet Function Tests: A Need or a Greed?
31 January 2020 (online)
Today, as the incidence of cardiovascular diseases increases, the use of antiplatelet therapy is widely recognized. This presents clinicians with the challenge of balancing the risk of thrombotic and bleeding complications. Platelet dysfunction is one of the chief causes of postoperative bleedings and their etiology is not fully understood. Platelets receptors point-of-care investigations are of a remarkable value in assessing patient’s risk of bleeding. Reliable assessment of platelet function can improve treatment and saves lives.
Patients with triple-vessel coronary artery disease are usually advised to stop antiplatelet medication a few days prior to coronary artery bypass graft surgery (CABG) to reduce the incidence of postoperative bleeding. The patients whose antiplatelet drugs are not stopped, before CABG, are at greater risk of postoperative hemorrhage. As of 2019, efforts are on to minimize blood transfusions. But, blood and blood products transfusion remains largely experiential and pragmatic. Hence, there is a need to have objective tests to demonstrate platelet dysfunction before platelet transfusion. Today, several devices perform platelet function tests which have been reported in clinical studies to evaluate platelet dysfunction and quantify the need for antiplatelet therapy. These devices range from highly sophisticated ones, such as light transmittance aggregometers and whole blood flow cytometers, to simple point-of-care technologies like the sonolcot, multiplate, thromboelastography (TEG), and thromboelastometry (ROTEM).
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