Does the platelet-activated clotting test (HemoSTATUS(R)) predict blood loss and platelet dysfunction associated with cardiopulmonary bypass?

Platelet dysfunction is a major cause of bleeding after cardiopulmonary bypass (CPB). No timely, simple, point-of-care determinant of platelet function is available for clinical use. Adding platelet-activating factor to conventional activated clotting time methods (platelet-activated clotting test [PACT]) (HemoSTATUS(R); Medtronic, Inc., Parker, CO) produces rapid results (<3 min) and may yield a measure of platelet responsiveness and whole blood procoagulant activity. Blood samples were drawn for PACT, platelet count, prothrombin time, activated partial thromboplastin time, and thromboelastogram (TEG) from 200 patients undergoing cardiac surgery. The PACT significantly decreased from the baseline to postprotamine time interval (P < 0.001). The PACT correlated with 4-h mediastinal blood loss (r = -0.30, P = 0.014). The TEG maximum amplitude also correlated with 4-h mediastinal blood loss (r = -0.32, P = 0.003). The PACT had a sensitivity and specificity comparable to routine laboratory coagulation tests in predicting blood loss. The TEG maximum amplitude, however, was more predictive than both the PACT and routine coagulation tests in this respect. The PACT may be a useful indicator of platelet responsiveness or whole blood procoagulant activity, but we did not find it superior to other tests of coagulation function for predicting excessive blood loss after CPB.