Impact of Platelet Testing on Presurgical Screening and Implications for Cardiac and Noncardiac Surgical Procedures

Bleeding is a common complication of cardiac surgery, accounting for a significant portion of the total transfusions performed in the United States. This may be due in part to surgical factors and to the fibrinolysis and platelet activation induced by cardiopulmonary bypass. The increasing frequency with which antiplatelet medications are used to prevent thrombosis in cardiac surgical patients with cardiovascular disease also elevates the risk for postoperative bleeding. The resulting coagulopathy and need for transfusions may increase morbidity and mortality risk in cardiac surgical patients, depending on the specific antiplatelet agent used, as well as on patient factors. Empiric platelet transfusion, the frequency of which varies greatly among institutions, does not reliably prevent these complications and may even increase the risk for adverse outcomes. Platelet function testing, particularly with newer testing systems, may be a valuable tool for making decisions about stopping antiplatelet drug administration, surgical timing with respect to bleeding risk, and platelet transfusion in cardiac surgical patients.