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. 2023 Nov 20;15(11):e49131.
doi: 10.7759/cureus.49131. eCollection 2023 Nov.

Platelet Function Testing Using Sonoclot and TEG6s as a Platelet Transfusion Prediction Tool in Open Heart Surgery

Tomoe Sato  1 , Mitsutaka Edanaga  1 , Michiaki Yamakage  1 , Ryo Harada  2 , Nobuyoshi Kawaharada  3
Affiliations

Platelet Function Testing Using Sonoclot and TEG6s as a Platelet Transfusion Prediction Tool in Open Heart Surgery

Tomoe Sato et al. Cureus. .

Abstract

Introduction The point-of-care test (POCT) is useful for blood coagulation management during cardiovascular surgery. Although thromboelastography (TEG6s) has been reported to have targeted benefits for blood transfusion in cardiac surgery, Sonoclot analysis has not yet been fully validated. In this study, we evaluated the accuracy of Sonoclot, especially platelet function (PF) as a platelet concentrate (PC) transfusion parameter, compared to TEG6s in cardiovascular surgery. Methods This single-center, prospective, randomised trial was conducted at a university hospital. Forty-two adult patients who underwent elective cardiac surgery requiring cardiopulmonary bypass were included in this study between 2017 and 2021. The participants were randomly assigned to the Sonoclot (S) or Sonoclot and TEG6s (ST) groups. The amount of intraoperative PC was determined according to the POCT parameter values at the time of protamine administration. In addition, we investigated the correlation between PF parameters of POCT and platelet count at the end of surgery. Results There was no statistically significant difference in the intraoperative PC volume between the two groups. The Sonoclot PF parameter, PF, was moderately correlated with platelet count at the end of surgery (r=0.5449, p=0.009), and the TEG6s PF parameter showed a strong correlation with platelet count at the end of surgery (r=0.7744, p<0.001). Conclusion There was no statistically significant difference in platelet transfusion volume between the Sonoclot and TEG6s in this study. The correlation between the PF of the Sonoclot and platelet count was moderate. This study suggests that PF of Sonoclot may be a potentiating indicator of PF.

Keywords: blood coagulation; cardiovascular surgery; sonoclot; thromboelastography; transfusion.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Coagulation and transfusion management algorithm during surgery
If oozing in the surgical field was observed even after administering FFP and PC, additional FFP was used. CPB: cardiopulmonary bypass, ACT: activated clotting time, POCT: point-of-care testing, CR: clot rate, PF: platelet function; FFP: fresh frozen plasma, PC: platelet concentrate, MAHKH: maximum amplitude in the kaolin with heparinase, S: Sonoclot, T: TEG6s
Figure 2
Figure 2. Schematic illustration of Sonoclot
PF represents the retraction rate of platelets, which is calculated and quantified based on the rising rate of the slope and the angle of the apex. PF: platelet function
Figure 3
Figure 3. Schematic illustration of TEG6s
MA reflects platelet-fibrin cross-link formation at the point of maximum clot strength (mm). MA: maximum amplitude
Figure 4
Figure 4. Flowchart of patient selection for group classification
S: Sonoclot, T: TEG6s
Figure 5
Figure 5. Correlation between platelet count and PF and platelet count and MAHKH at the end of surgery
PF: platelet function; MAHKH: maximum amplitude in the kaolin with heparinase
Figure 6
Figure 6. Supplemental data. The changes in platelet count(a) and platelet function of Sonoclot and TEG6s (b, c) through surgery
S: Sonoclot, T: TEG6s, PF: platelet function, MAHKH: maximum amplitude in the kaolin with heparinase
See this image and copyright information in PMC

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