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Intraoperative infusion of noradrenaline improves platelet aggregation in patients undergoing coronary artery bypass grafting: a randomized controlled trial

Journal article
Authors Sukhi Singh
Tor Damén
Mikael Dellborg
Anders Jeppsson
Anders Nygren
Published in Journal of Thrombosis and Haemostasis
Volume 17
Issue 4
Pages 657-665
ISSN 1538-7933
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 657-665
Language en
Links dx.doi.org/10.1111/jth.14408
Keywords acetylsalicylic acid, cardiac surgical procedures, noradrenaline, platelet aggregation, platelet function, blood-samples, clopidogrel, ticagrelor, aggregometry, adrenaline, activation, anesthesia, vivo
Subject categories Cardiac and Cardiovascular Systems, Hematology

Abstract

Background New approaches to prevent bleeding complications during cardiac surgery are needed. Objective To investigate if noradrenaline (NA) enhances platelet aggregation in patients undergoing coronary artery bypass grafting (CABG). Patients/Methods Twenty-four patients undergoing coronary artery bypass grafting (CABG) were included in a prospective parallel-group randomized study. All patients but one were treated with acetylsalicylic acid (ASA). In the treatment group (n = 12), mean arterial blood pressure (MAP) was maintained at pre-induction levels by NA infusion. In the control group (n = 12), NA was administered only if MAP decreased below 60 mmHg. Platelet aggregation (impedance aggregometry with ADP, arachidonic acid [AA] and thrombin-receptor activating peptide [TRAP] as initiators) and clot formation (clotting time, clot formation time and maximum clot firmness by EXTEM, INTEM and FIBTEM tests with thromboelastometry) were assessed before and 50 min after anesthesia induction (before cardiopulmonary bypass was initiated). Results All patients in the treatment group received NA (median dose after 50 min 0.09 (range 0-0.26) mu g kg(-1) min(-1)). Four patients in the control group also received NA (0.03-0.12 mu g kg(-1) min(-1)). There were differences between the treatment group and the control group in ADP- and AA-induced aggregation changes (ADP, +16 [25th-75th percentiles, 5-26] vs. -7 [-19 to -1] U; AA, +12 [-4 to 16] vs. -9 [-13 to 1] U). INTEM maximum clot firmness increased in the treatment group but not in the control group. Conclusion Infusion of clinically relevant doses of NA enhanced platelet aggregation and clot firmness in ASA-treated CABG patients. NA infusion is hence a potential new method to acutely improve platelet reactivity in patients on antiplatelet therapy undergoing surgery.

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