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Eur J Cardiothorac Surg 2003;23:1046-1050
© 2003 Elsevier Science NL

Heart surgery with extracorporeal circulation leads to platelet activation at the time of hospital discharge

^a St. Elisabeth Heart Centre, Norwegian University of Science and Technology, 7018 Trondheim, Norway
^b Department of Immunology and Transfusion Medicine/Institute of Laboratory Medicine, Norwegian University of Science and Technology, 7018 Trondheim, Norway

Received 29 September 2002; received in revised form 15 February 2003; accepted 6 March 2003.

^* Corresponding author. Tel.: +47-7386-7000, fax: +47-7386-7029
e-mail: alexander.wahba{at}rit.no

Objective: Heart surgery with extracorporeal circulation has a marked effect on platelet function and coagulation accounting for abnormal blood loss and allegedly a low incidence of thromboembolic complications. Little is known about platelet function at the time of hospital discharge of routine patients. Methods: Blood samples from 91 patients undergoing elective heart surgery were drawn before surgery and prior to discharge. Thirty-seven patients underwent coronary artery surgery and 54 an aortic valve implantation. The mean age of patients was 69±9 years. Fifty patients were male and 41 female. Platelet function was evaluated using plasma ß-thromboglobulin quantification in enzyme-linked immunosorbent assay. In addition, flow cytometric analysis of platelet–monocyte conjugates and platelet–neutrophil conjugates was performed. Results: The platelet count before discharge was significantly increased (265±86 vs. 212±61x10⁹/l preoperatively). ß-Thromboglobulin was significantly increased (176±127 vs. 79±70 ng/ml preoperatively) and flow cytometry proved a significant increase in monocyte–platelet aggregates (8.3±5.4% vs. 5.3±2.6% preoperatively) indicating platelet activation at the time of hospital discharge. There were no significant differences among the three subgroups coronary surgery, mechanical valve insertion and biological valve insertion. Conclusions: Heart surgery with extracorporeal circulation leads to significant platelet activation and a reactive increase in platelet count before discharge. This is in contrast to the reduced platelet function immediately postoperatively.

Key Words: Platelet function • Cardiopulmonary bypass • Coronary artery surgery • Heart valve surgery • Flow cytometry

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