Details

Autor(en) / Beteiligte

• Nammas, Wail
• Dalén, Magnus
• Rosato, Stefano
• Gherli, Riccardo
• Reichart, Daniel
• Gatti, Giuseppe
• Onorati, Francesco
• Faggian, Giuseppe
• De Feo, Marisa
• Bancone, Ciro
• Chocron, Sidney
• Khodabandeh, Sorosh
• Santarpino, Giuseppe
• Rubino, Antonino S.
• Maselli, Daniele
• Nardella, Saverio
• Salsano, Antonio
• Gherli, Tiziano
• Nicolini, Francesco
• Zanobini, Marco
• Saccocci, Matteo
• Bounader, Karl
• D'Errigo, Paola
• Kiviniemi, Tuomas
• Kinnunen, Eeva-Maija
• Perrotti, Andrea
• Airaksinen, Juhani
• Mariscalco, Giovanni
• Ruggieri, Vito G.
• Biancari, Fausto

Titel

Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting

Ist Teil von

• Platelets (Edinburgh), 2019-05, Vol.30 (4), p.480-486

Ort / Verlag

England: Taylor & Francis

Erscheinungsjahr

2019

Beschreibungen/Notizen

• The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 10 9 /L and it was considered moderate-severe when preoperative platelet count was <100 × 10 9 /L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management. Among 7189 patients included in this analysis, 599 (8.3%) had preoperative thrombocytopenia. Patient with preoperative thrombocytopenia had an increased chest drainage output at 12 h (mean, 519 vs. 456 mL, adjusted coeff. 39, 95%CI 18-60) and rates of severe-massive bleeding (Universal Definition of Perioperative Bleeding (UDPB) severity grades 3-4: 12.7% vs. 8.1%, adjusted OR 1.47, 95%CI 1.11-1.93; E-CABG bleeding severity grades 2-3: 10.4% vs. 6.1%, adjusted OR 1.78, 95%CI 1.30-2.43). Thrombocytopenia was associated with an increased risk of hospital/30-day death (3.2% vs. 1.9%, adjusted OR 2.02, 95%CI 1.20-3.42), 1-year death (5.7% vs. 3.4%, adjusted HR 1.68, 95%CI 1.16-2.44), deep sternal wound infection (3.5% vs. 2.4%, adjusted OR 1.65, 95%CI 1.02-2.66), acute kidney injury (28.1% vs. 22.2%, OR 1.45, 1.18-1.78), and prolonged stay in the intensive care unit (mean, 3.6 vs 2.8 days, adjusted coeff. 0.74, 95%CI 0.40-1.09). Similar results were observed in a subset of patients with moderate-severe thrombocytopenia (51 patients, 0.7%). In particular, these patients had a markedly higher rate of acute kidney injury (40%, adjusted OR, 1.94, 95%CI 1.05-3.57), resternotomy for bleeding (7.8%, adjusted OR 3.49, 95%CI 1.20-10.21), and severe-massive bleeding (UDPB severity grades 3-4: 23.5%, adjusted OR 3.08, 95%CI 1.52-6.22; E-CABG bleeding severity grades 2-3: 23.5%, adjusted OR 4.43, 95%CI 2.15-9.15) compared to patients with normal preoperative platelet count. Mild preoperative thrombocytopenia is associated with increased risk of severe-massive bleeding, mortality, and other major adverse events after CABG. Such risks are markedly increased in patients with moderate-severe preoperative thrombocytopenia.