Original Articles

Impact of a Phosphorylcholine-Coated Cardiac Bypass Circuit on Blood Loss and Platelet Function: A Prospective, Randomized Study

Address correspondence to: Sandrine Marguerite, MD, Service d’Anesthésie Réanimations Chirurgicales, Nouvel Hôpital Civil, 1, Place de l’Hôpital BP 426, 67091 Strasbourg Cedex, France. E-mail: Sandrine.marguerite@chru-strasbourg.fr

Received: 16 May 2011
Accepted: 1 February 2012

Abstract

Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve repair (n = 20) using CPB. Patients were randomized either to PC-coated CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients in each group). Blood loss and transfusion needs were evaluated intra- and postoperatively. Markers of platelet activation and thrombin generation were measured at anesthesia induction, at the beginning and end of CPB, on skin closure, and on days 0, 1, and 5. Comparisons were made by Student’s t test or covariance analysis (significance threshold p ≤ .05). Blood loss was significantly lower in the PC group during the first 6 postoperative hours (171 ± 102 vs. 285 ± 193 mL, p = .024), at the threshold of significance from 6–24 hours (p = .052), and similar in both groups after 24 hours. During CPB, platelet count decreased by 48% in both groups. There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.