Ann Surg Treat Res.  2022 Oct;103(4):227-234. 10.4174/astr.2022.103.4.227.

Is the platelet function test effective in predicting blood loss in patients undergoing hepatic resection?

• Gwon JG
• Ko SY
• Kim H

• KMID: 2534126
• DOI: http://doi.org/10.4174/astr.2022.103.4.227

Abstract

Purpose
The platelet function analyzer (PFA)-100/200 is widely used to assess platelet function. However, its role in predicting the perioperative risk of bleeding in patients undergoing liver resection remains controversial. Therefore, we aimed to ascertain whether the platelet function test could be useful in predicting bleeding risk in patients undergoing hepatic surgery.
Methods
The study participants were patients who underwent hepatectomy for hepatocellular carcinoma at our hospital over a period of 10 years from January 1, 2010 to May 31, 2020. PFA-200 values of these patients were divided into 2 groups; normal (n = 333) and prolonged (n = 39).
Results
There were no significant differences regarding the volumes of calculated blood loss during surgery between the normal and prolonged PFA groups (879.55 ± 1,046.50 mL vs. 819.74 ± 912.64 mL, respectively; P = 0.733); intraoperative RBC transfusion (0.52 ± 2.02 units vs. 0.26 ± 1.02 units, P = 0.419) and postoperative RBC transfusion (0.24 ± 1.17 units vs. 0.46 ± 1.97 units, P = 0.306) were similar between the 2 groups, respectively. Multivariate analysis revealed no association between PFA closure time and calculated blood loss (hazard ratio, 1.06; P = 0.881). Moreover, there was no association between PFA closure time and preoperative laboratory results or assessment of tool-related liver function in multivariate analysis.
Conclusion
There was no correlation between the amount of blood loss and platelet function in patients who underwent liver resection. In patients undergoing liver resection who are not managed on antiplatelet agents or do not have chronic kidney disease, the use of routine PFA is not recommended.

Keyword

Bleeding; Hepatectomy; Liver; Platelet function tests

Figure

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  Fig. 1 Enrollment flowchart. HCC, hepatocellular carcinoma; PFA, platelet function analyzer; ICG, indocyanine green; CVD, cardiovascular disease; CKD, chronic kidney disease.

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  Fig. 2 Platelet function analyzer (PFA) values according to liver function-related markers. (A) ICG-R15 test, (B) platelet count, (C) PT/INR, and (D) total bilirubin. ICG-R15, indocyanine green 15-minute clearance retention rate; INR, international normalized ratio.

Reference

1. Romano F, Garancini M, Uggeri F, Degrate L, Nespoli L, Gianotti L, et al. Bleeding in hepatic surgery: sorting through methods to prevent it. HPB Surg. 2012; 2012:169351. PMID: 23213268.

2. Rodgers RP, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost. 1990; 16:1–20.

3. Harrison P. Progress in the assessment of platelet function. Br J Haematol. 2000; 111:733–744. PMID: 11122132.

4. Favaloro EJ. Clinical utility of the PFA-100. Semin Thromb Hemost. 2008; 34:709–733. PMID: 19214910.

5. Paniccia R, Priora R, Liotta AA, Abbate R. Platelet function tests: a comparative review. Vasc Health Risk Manag. 2015; 11:133–148. PMID: 25733843.

6. Mahla E, Tantry US, Prüller F, Gurbel PA. Is there a role for preoperative platelet function testing in patients undergoing cardiac surgery during antiplatelet therapy? Circulation. 2018; 138:2145–2159. PMID: 30474416.

7. Malm CJ, Hansson EC, Åkesson J, Andersson M, Hesse C, Shams Hakimi C, et al. Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study. Br J Anaesth. 2016; 117:309–315. PMID: 27543525.

8. Ranucci M, Pistuddi V, Di Dedda U, Menicanti L, De Vincentiis C, Baryshnikova E. Platelet function after cardiac surgery and its association with severe postoperative bleeding: the PLATFORM study. Platelets. 2019; 30:908–914. PMID: 30365338.

9. Kudo M, Kitano M, Sakurai T, Nishida N. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the Liver Cancer Study Group of Japan. Dig Dis. 2015; 33:765–770. PMID: 26488173.

10. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008; 140:496–504. PMID: 18275427.

11. Wada H, Usui M, Sakuragawa N. Hemostatic abnormalities and liver diseases. Semin Thromb Hemost. 2008; 34:772–778. PMID: 19214915.

12. Lee AJ, Kim SG. Utility of preoperative in vitro platelet function tests for predicting bleeding risk in patients undergoing functional endoscopic sinus surgery. J Blood Med. 2016; 7:235–238. PMID: 27799837.

13. Jeon Y, Lee WI, Kang SY, Kim MH. Limitations of preoperative PFA-200 as a predictor of postoperative blood loss in total knee arthroplasty: according to use of tranexamic acid. Clin Lab. 2017; 63:1121–1128. PMID: 28792707.

14. Yu ES, Jeon MJ, Kang KW, Lee BH, Kang EJ, Park Y, et al. The role of platelet function analyzer-200 in predicting perioperative bleeding risk. Korean J Intern Med. 2020; 35:1199–1209. PMID: 32019292.

15. Jiang H, Li Y, Sheng Q, Dou X. Relationship between Hepatitis B virus infection and platelet production and dysfunction. Platelets. 2022; 33:212–218. PMID: 34806523.