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Using Cone and Plate(let) Analyzer to Predict Bleeding in Cardiac Surgery

Department of Cardiothoracic Surgery, Assuta Medical Center, Tel Aviv, Israel
¹ Coagulation Unit, Department of Hematology
² Department of Medical Biochemistry, Hebrew University, Hadassah Medical School, Jerusalem, Israel
³ Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
⁴ Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical School, Jerusalem, Israel

For reprint information contact: Rabin Gerrah, MD Tel: 972 3 520 1436 Fax: 972 3 520 1747 Email: rabin{at}assuta.com, Cardiothoracic Surgery, Assuta Medical Center, 62 Jabotinsky Street, Tel Aviv 62748, Israel.

The cone and plate(let) analyzer is an established method for assessing platelet function. It evaluates adherence of platelets on an extracellular matrix, expressed as a percentage of surface coverage and the average size of the aggregates. The purpose of this study was to determine the applicability of the cone and plate(let) analyzer in monitoring platelet function and predicting postoperative bleeding. The relationship between postoperative bleeding, perioperative platelet function, and other parameters was studied. A significant decrease in surface coverage was detected upon establishment of cardiopulmonary bypass (from 6.9% ± 3.9% to 4.7% ± 1.7%) with a return to preoperative values at the end of surgery. Preoperative average size and surface coverage were the only parameters that significantly and linearly correlated with postoperative bleeding. Patients with an aggregate average size < 20 µm² had a significantly higher incidence of severe bleeding (> 965 mL) than those with a size > 20 µm² (44% vs. 0%), and a higher mean blood loss (908 ± 322 mL vs. 337 ± 78 mL). Similar results were obtained for surface coverage < 5%, indicating the predictive value of these parameters. Preoperative platelet function as evaluated by the cone and plate(let) analyzer is an independent risk factor determining postoperative bleeding.