Intraoperative changes in platelet function in relation to moderate haemorrhage

Jonathan J Hetherington, Isobel Ford, G Patrick Ashcroft, Jan O Jansen

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4 Citations (Scopus)
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BACKGROUND: Haemorrhage is associated with haemostatic dysfunction. Previous studies have focused on coagulation factors, but platelet function plays an equally important role. The time course of alterations in platelet function in relation to injurious stimuli is not known.

AIM: To evaluate short-term, intra-operative changes in platelet function, by whole blood impedance aggregometry in patients undergoing hip arthroplasty. The primary outcome was platelet aggregation in response to adenosine diphosphate (ADP) stimulation. We also evaluated other agonists, and the feasibility of conducting platelet aggregometry measurement in the operating theatre.

METHODS: Patients undergoing primary cemented hip arthroplasty had six peri-operative arterial blood samples analysed at pre-set stages of the operation, using the Multiplate® Impedance Aggregometer. Four agonists were used: ADP, TRAP, Collagen and Arachidonic Acid.

RESULTS: There was a statistically significant change (p<0.05, ANOVA) in platelet response to ADP over the course of the operations. The trend demonstrated an initial decrease in responsiveness, followed by increased platelet responsiveness in the later stages. Other agonists (TRAP, COL, ASPItest) demonstrated a similar pattern of changes. Of 360 tests conducted, 12 (3.3%) had to be re-run due to poor intra-assay variability. Satisfactory values were obtained on the second attempt in all 12 samples.

CONCLUSION: Platelet function, as measured by impedance aggregometry, changes in response to a surgical stimulus involving blood loss. The clinical significance of these changes, and the potential of manipulating them for therapeutic purposes, remains to be elucidated.

Original languageEnglish
Pages (from-to)1198-1202
Number of pages5
JournalThrombosis Research
Issue number6
Early online date10 Apr 2015
Publication statusPublished - Jun 2015

Bibliographical note

Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

The study was funded by TENOVUS Scotland (G12/14). Jan Jansen is in receipt of salary support through the NHS Research Scotland (NRS) fellowship scheme.

The authors are extremely grateful for the expert assistance and contributions of Dr Neil Scott (Medical Statistician, University of Aberdeen), Win Culley (Research Nurse, Woodend Hospital), Dr Karen Cranfield (Consultant Anaesthetist), and Ms Sharon Wood, (Research Technician, Rowett Institute of Nutrition and Health) for fibrinogen measurement.


  • haemorrhage
  • platelet aggregation
  • platelet function tests
  • surgery


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