Document Detail

Value of a single preoperative PFA-100 measurement in assessing the risk of bleeding in patients taking cyclooxygenase inhibitors and undergoing total knee replacement.
MedLine Citation:
PMID:  19411670     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The usefulness of the PFA-100 in assessing the risk of bleeding in non-cardiac surgery is not clear. This study aims to examine this by correlating preoperative PFA-100 measurement with perioperative bleeding in patients receiving cyclooxygenase (COX) inhibitors. METHODS: PFA-100 with adenosine-5'-diphosphate (ADPCT) and epinephrine (EPICT) cartridges were measured before operation in consecutive patients undergoing elective total knee replacement and taking different COX inhibitors. Surgery and anaesthesia were performed by the same team using standardized techniques. Intraoperative blood loss and postoperative drain output were recorded by anaesthetists and nurses blinded to the PFA-100 measurements. Surgeons, similarly blinded, were asked to rate the quality of haemostasis. Correlation was sought between these data and PFA-100 measurements. RESULTS: Thirty patients were studied, involving 51 knees. Preoperative PFA-100 EPICT was correlated with drain output (r=0.30, P=0.03). The correlation becomes stronger when a 20% in vitro haemodiluted sample was used for measurement (r=0.42, P=0.01). Receiver-operating characteristic curve analysis using the diluted measurements [area under curve (AUC) 0.74 (95% CI 0.54-0.94)] suggested using a cut-off value of 188 s for EPICT, which will predict excessive drain output with 89% sensitivity, 54% specificity, and a likelihood ratio of 1.93. Diluted EPICT was also correlated with surgeon rating of haemostasis (r=0.36, P=0.04) although none of the measurements correlated with intraoperative blood loss. CONCLUSIONS: Preoperative PFA-100 prolongation is correlated with increased postoperative drain output. It can be a potentially useful preoperative measurement in patients taking COX inhibitors.
K F J Ng; J-C Lawmin; S F Tsang; W M Tang; K Y Chiu
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-02
Journal Detail:
Title:  British journal of anaesthesia     Volume:  102     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-19     Completed Date:  2009-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  779-84     Citation Subset:  IM    
Department of Anaesthesiology, The University of Hongkong, Room 424, Block K, Queen Mary Hospital Hongkong, Hongkong SAR, China.
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MeSH Terms
Arthroplasty, Replacement, Knee*
Blood Loss, Surgical
Cyclooxygenase Inhibitors / adverse effects*
Middle Aged
Platelet Function Tests / instrumentation,  methods*
Point-of-Care Systems
Postoperative Hemorrhage / blood*,  chemically induced
Preoperative Care / methods*
Risk Assessment / methods
Single-Blind Method
Reg. No./Substance:
0/Cyclooxygenase Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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