• Seema Agarwal, Robert Ian Johnson, and Matthew Shaw.
• Departments of Anaesthesia and Critical Care. Electronic address: Seema.Agarwal@lhch.nhs.uk.
• J. Cardiothorac. Vasc. Anesth. 2015 Apr 1;29(2):333-41.

ObjectiveTo investigate if the use of preoperative platelet function testing (PFT) as part of a transfusion algorithm reduced blood product usage in coronary artery bypass surgery (CABG).DesignProspective, randomized, controlled trial.SettingA cardiothoracic hospital.Participants249 patients having CABG surgery.InterventionsThe patients were allocated randomly to PFT preoperatively with Multiple Electrode Aggregometry (MEA, Group A), TEG PlateletMapping (PM, Group B) or none (control, Group C). Post-bypass bleeding management was determined by a transfusion algorithm.Measurements And Main ResultsThe primary outcome measure was blood product transfusion in the first 48 hours post-surgery. There was a significant reduction in all blood product transfusion between Groups A (MEA) and B (PM) and Group C (control) (median number of units transfused, 2 (A)/2 (B)/ 4(C), p=0.02). Those in A and B received fewer units of red cells (median number of units, 0 (A)/1 (B) /2 (C), p=0.006) and fresh frozen plasma than the control Group C (median number of units, 0 (A)/0 (B)/2 (C), p<0.001), without receiving significantly more units of platelets (median number of units, 1 (A)/1 (B)/0 (C), p=0.11). In those who had taken an adenosine disphosphate (ADP)-receptor antagonist within 5 days (n=173), these results were amplified, and additionally, there was a significant cost saving (median cost, A=£1738.53, B=£1736.96, C=£3191.80 p=0.006).ConclusionPreoperative PFT as part of a point-of-care testing-based transfusion algorithm led to a reduction in blood transfusion. There is a potential cost saving in those who have taken an ADP-receptor antagonist within 5 days.Copyright © 2015 Elsevier Inc. All rights reserved.

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