Platelet dysfunction in critically ill patients

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Thrombelastography Platelet Mapping (TEG-PM) allows for measurement of maximal potential clot strength (MA) and strength from stimulation of arachidonic acid (MA-AA) and adenosine disphosphate (MA-ADP) receptors. This study was conducted to assess degree of platelet dysfunction in critically ill adult patients. A retrospective study of critically ill, adult, nontrauma patients in a medical/surgical ICU was conducted from August 2013 to September 2014. All patients who underwent TEG-PM were enrolled. Patients with intracerebral hemorrhage, following cardiac surgery, or without an APACHE II score were excluded. Patients were divided into those with and without aspirin use. Demographics, APACHE II score, and laboratory results were abstracted. Student t test was used to test significance. A total of 79 patients were enrolled (61% male). Average age and APACHE II score were 61 ± 16 years and 18 ± 9, respectively. Factor-associated coagulation measures and MA were normal in all groups but MA-AA and MA-ADP were significantly reduced irrespective of anticoagulant use. Compared to the nonanticoagulated cohort, MA-AA was significantly reduced in those on aspirin. There was no difference in mortality or length of stay in any cohort. Inhibition of the AA and ADP pathways is common in critically ill patients. Clinical correlation with propensity for bleeding and need for transfusion requires further assessment.

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