DISCUSSION
We hypothesized that IPC and IPF would have an impact on intra- and postoperative bleeding in patients with CABG, and thus, these parameters would be associated with the number or volume of transfusions. Our findings showed that IPC and IPF were negatively correlated with the amount of blood components transfused intraoperatively, albeit weakly. Preoperative IPC was also found to be weakly correlated with postoperative drainage at the 12th hour. However, neither IPC nor IPF were associated with the total amount of blood components used throughout hospitalization, and they also had no relationship with the length of hospital stay.
Parallel to the increase in technical advances and number of the angiographies performed to diagnose the presence of the coronary artery disease, the number of the patients scheduled for CABG has increased in recent years.9,10 The CABG procedure is currently the standard of care for treatment of multivessel coronary artery disease, particularly in subjects with concomitant diabetes and left ventricular systolic dysfunction.11-13 However, it still has an in-hospital mortality rate of about 3% and it has been established that intra-and postoperative bleeding events account for a considerable portion of the mortality associated with CABG procedures .14
Several factors, including reduced coagulation factors and a low platelet count may lead to coagulopathy following CABG. Previous data have shown that platelet counts after CABG are independent predictors of excessive blood loss.15 A prolonged closure time, which indicates platelet dysfunction, has been shown to predict blood product transfusion in children undergoing cardiac surgery.16 Studies utilizing multiple electrode impedance aggregometry (MEIA) and light transmission aggregometry (LTA) demonstrated significant platelet dysfunction after CABG, with partial recovery within 24 hours after surgery .17
Immature platelet count and IPF, which represent the young cells that have recently been released into the circulation, are considered to be associated with platelet function. These young platelets have a greater number of granules and higher volume than the older ones, and thus, may be more effective in facilitating homeostasis in case of bleeding.7 Although platelet count and platelet dysfunction measured by different techniques have been shown to precipitate excessive bleeding after CABG, there is currently no data concerning the impact of IPC and IPF on postoperative bleeding in patients undergoing CABG.18-20 Our study is the first to demonstrate real-life data regarding the association of IPC and IPF with postoperative drainage and need for transfusion in patients who had undergone CABG. We found that IPF increases shortly after CABG compared to preoperative values, however, IPC returns to baseline values on the 5th postoperative day. Our findings show that preoperative IPF has a weak correlation with the amount of blood components transfused intraoperatively. Nonetheless, IPF has no significant association with the total amount of the blood components used throughout hospitalization and the length of the hospital stay. These findings show that IPF has limited value to predict postoperative drainage and the need for postoperative blood transfusion.