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.