{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:17:44Z","timestamp":1787242664911,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Postoperative bleeding remains a major complication following coronary artery bypass grafting (CABG), contributing to transfusion requirements, reintervention, and morbidity. The objective of this study was to assess the clinical significance of preoperative platelet function testing and postoperative viscoelastic testing in patients undergoing elective isolated on-pump CABG. Methods: This prospective observational study included 708 patients undergoing surgery between January 2023 and January 2025. Preoperative platelet function was assessed with Multiplate\u00ae impedance aggregometry (ADPHS and ASPI), and postoperative coagulation was assessed with ClotPro\u00ae after cardiopulmonary bypass. The prespecified Multiplate thresholds were population- and assay-specific and were not intended as universal cutoffs. Postoperative bleeding was defined by cumulative chest-tube drainage during the first 24 h. Results: In unadjusted analyses, low ADPHS values (\u2264602.5 AU\u00b7min) were associated with higher platelet transfusion, cryoprecipitate use, and overall transfusion, and ADPHS showed modest discrimination for blood loss &gt; 500 mL\/24 h (AUC = 0.61, p = 0.041). Low ASPI values (\u2264453 AU\u00b7min) were associated with increased cryoprecipitate use and showed modest discrimination for blood loss &gt; 1000 mL\/24 h (AUC = 0.62, p = 0.005). After multivariable adjustment for baseline differences, neither ADPHS \u2264 602.5 (adjusted OR 1.01, 95% CI 0.74\u20131.39, p = 0.936) nor ASPI \u2264 453 (adjusted OR 0.89, 95% CI 0.64\u20131.23, p = 0.475) was independently associated with postoperative bleeding &gt; 500 mL\/24 h. Postoperative ClotPro\u00ae parameters showed statistically significant associations with transfusion and bleeding, but their discriminatory performance was limited. Conclusions: Perioperative platelet function and viscoelastic test results were associated with bleeding and transfusion outcomes in unadjusted analyses, but discrimination was modest, and the platelet function cutoffs were not independently associated with bleeding &gt; 500 mL after adjustment. These findings support a complementary hemostatic assessment role for combined POC testing but do not establish a standalone predictive model or an implementable transfusion algorithm.<\/jats:p>","DOI":"10.3390\/jcm15166440","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:48:31Z","timestamp":1787219311000},"page":"6440","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Clinical Significance of Pre- and Postoperative Platelet Function Testing in Coronary Artery Bypass Grafting Surgery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-0850","authenticated-orcid":false,"given":"Milos","family":"Matkovic","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Novakovic","sequence":"additional","affiliation":[{"name":"Department of Clinical Transfusion Medicine in Cardiovascular Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Milojevic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Milicevic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-2383","authenticated-orcid":false,"given":"Jelena Milin","family":"Lazovic","sequence":"additional","affiliation":[{"name":"Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Tutus","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7992-7279","authenticated-orcid":false,"given":"Filip","family":"Markovic","sequence":"additional","affiliation":[{"name":"Clinic for Pulmology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nenad","family":"Lalovic","sequence":"additional","affiliation":[{"name":"University Hospital Foca, 73300 Foca, Bosnia and Herzegovina"},{"name":"Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milorad","family":"Bijelovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina"},{"name":"Thoracic Surgery Clinic, Institute for Pulmonary Diseases of Vojvodina, 21208 Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vuk","family":"Aleksic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina"},{"name":"Clinical Hospital Center Zemun, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8606-9559","authenticated-orcid":false,"given":"Nemanja","family":"Aleksic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1051\/ject\/202153097","article-title":"STS\/SCA\/AmSECT\/SABM Update to the Clinical Practice Guidelines on Patient Blood Management","volume":"53","author":"Tibi","year":"2021","journal-title":"J. Extra Corpor. Technol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rancati, V., Scala, E., Ltaief, Z., Gunga, M.Z., Kirsch, M., Rosner, L., and Marcucci, C. (2021). Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112454"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.athoracsur.2013.03.015","article-title":"Major bleeding, transfusions, and anemia: The deadly triad of cardiac surgery","volume":"96","author":"Ranucci","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1537-2995.2012.03697.x","article-title":"The association of blood transfusion with mortality after cardiac surgery: Cause or confounding? (CME)","volume":"53","author":"Dixon","year":"2013","journal-title":"Transfusion"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.mayocpiqo.2022.09.006","article-title":"Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis","volume":"6","author":"Shah","year":"2022","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1080\/09537104.2016.1237626","article-title":"Platelet function testing in cardiac surgery: A comparative study of electrical impedance aggregometry and thromboelastography","volume":"28","author":"Kirmani","year":"2017","journal-title":"Platelets"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1007\/s12630-018-1217-9","article-title":"Point-of-care viscoelastic hemostatic testing in cardiac surgery patients: A systematic review and meta-analysis","volume":"65","author":"Lodewyks","year":"2018","journal-title":"Can. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12959-021-00313-7","article-title":"Point-of-care detection and differentiation of anticoagulant therapy\u2014Development of thromboelastometry-guided decision-making support algorithms","volume":"19","author":"Otto","year":"2021","journal-title":"Thromb. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ezae352","DOI":"10.1093\/ejcts\/ezae352","article-title":"2024 EACTS\/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP","volume":"67","author":"Casselman","year":"2025","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1111\/jocs.15284","article-title":"The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational trial","volume":"36","author":"Matkovic","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.thromres.2015.04.037","article-title":"Preoperative platelet aggregation predicts perioperative blood loss and rethoracotomy for bleeding in patients receiving dual antiplatelet treatment prior to coronary surgery","volume":"136","author":"Plicner","year":"2015","journal-title":"Thromb. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1080\/09537104.2017.1280148","article-title":"The interaction between preoperative platelet count and function and its relationship with postoperative bleeding in cardiac surgery","volume":"28","author":"Ranucci","year":"2017","journal-title":"Platelets"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/bja\/aew189","article-title":"Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: A prospective observational study","volume":"117","author":"Malm","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1080\/09537104.2018.1542123","article-title":"Perioperative point of care platelet function testing and postoperative blood loss in high-risk cardiac surgery patients","volume":"30","author":"Vlot","year":"2019","journal-title":"Platelets"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.athoracsur.2010.11.078","article-title":"2011 update to the society of thoracic surgeons and the society of cardiovascular anesthesiologists blood conservation clinical practice guidelines","volume":"91","author":"Ferraris","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/ejcts\/ezy289","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"55","author":"Neumann","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/14017431.2016.1231935","article-title":"Platelet inhibition and bleeding complications in cardiac surgery: A review","volume":"50","author":"Hansson","year":"2016","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1001\/jama.2011.290","article-title":"Standard- vs. high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: The GRAVITAS randomized trial","volume":"305","author":"Price","year":"2011","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1053\/j.jvca.2014.06.025","article-title":"Preoperative point-of-care platelet function testing in cardiac surgery","volume":"29","author":"Agarwal","year":"2015","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_20","first-page":"84","article-title":"Utility of Platelet Function Testing in Cardiac Surgery in 2021","volume":"5","author":"Gandhi","year":"2021","journal-title":"J. Card. Crit. Care TSS"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.athoracsur.2024.06.039","article-title":"Cardiac Surgical Bleeding, Transfusion, and Quality Metrics: Joint Consensus Statement by the Enhanced Recovery After Surgery Cardiac Society and Society for the Advancement of Patient Blood Management","volume":"119","author":"Salenger","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_22","first-page":"2","article-title":"The predictive value of platelet function point-of-care tests for postoperative blood loss and transfusion in routine cardiac surgery: A systematic review","volume":"63","author":"Petricevic","year":"2015","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1111\/trf.16075","article-title":"Viscoelastic testing in cardiac surgery","volume":"60","author":"Agarwal","year":"2020","journal-title":"Transfusion"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"249.e1","DOI":"10.1016\/j.jtcvs.2011.04.007","article-title":"Patient blood management during cardiac surgery: Do we have enough evidence for clinical practice?","volume":"142","author":"Ranucci","year":"2011","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S178","DOI":"10.1016\/j.jtcvs.2012.12.083","article-title":"Fibrinogen concentrate reduces intraoperative bleeding when used as first-line hemostatic therapy during major aortic replacement surgery: Results from a randomized, placebo-controlled trial","volume":"145","author":"Hanke","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.jvca.2019.06.030","article-title":"Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis","volume":"34","author":"Meco","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100031","DOI":"10.1016\/j.rpth.2022.100031","article-title":"Viscoelastic testing: An illustrated review of technology and clinical applications","volume":"7","author":"Hartmann","year":"2023","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_28","first-page":"CD007871","article-title":"Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding","volume":"2016","author":"Wetterslev","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.jss.2016.03.008","article-title":"Point-of-care thromboelastography\/thromboelastometry-based coagulation management in cardiac surgery: A meta-analysis of 8332 patients","volume":"203","author":"Deppe","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/ALN.0b013e318264c644","article-title":"Point-of-care testing: A prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients","volume":"117","author":"Weber","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1213\/ANE.0000000000007714","article-title":"Less Is More for Bleeding Management Algorithms in Cardiac Surgery: A Network Meta-Analysis and Meta-Regression of Randomized Studies","volume":"142","author":"Barbaria","year":"2026","journal-title":"Anesth. Analg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.hlc.2025.01.003","article-title":"Efficacy and Safety of Desmopressin in Terms of Bleeding and Transfusion in Cardiac Surgery With Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis","volume":"34","author":"Picchio","year":"2025","journal-title":"Heart Lung Circ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/anae.16463","article-title":"Viscoelastic haemostatic assays to guide therapy in elective surgery: An updated systematic review and meta-analysis","volume":"80","author":"Dias","year":"2025","journal-title":"Anaesthesia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1053\/j.jvca.2024.11.028","article-title":"Use of Intraoperative Hemostatic Checklists for Blood Management in Patients Undergoing Cardiac Surgery: A Scoping Review","volume":"39","author":"Irabor","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1053\/j.jvca.2024.03.011","article-title":"Methodologic Quality and Pharmacotherapy Recommendations for Patient Blood Management Guidelines for Cardiac Surgery on Cardiopulmonary Bypass","volume":"38","author":"Huang","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6440\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T10:09:54Z","timestamp":1787220594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":35,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166440"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166440","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}