Status and clinical significance of thrombocytopenia after cardiac surgery in adults_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zina ¹ , CHANG Shuo ¹ , LIU Na ² , LIU Ping ¹ ,  SUN Hansong ¹

1. Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Blood Transfusion, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

SUN Hansong, Email: drsunhs@sina.com

Keywords：

Cardiac surgery; thrombocytopenia; postoperative recovery

DOI：

10.7507/1007-4848.202009079

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the status of thrombocytopenia in adult patients after cardiac surgery, and to explore its mechanism and clinical significance.Methods Retrospective analysis of 240 patients after cardiac surgery in the 2^nd ward of surgical intensive care unit (ICU) of Fuwai Hospital from May to June 2020 was conducted, including 137 males and 103 females with a mean age of 56.0±12.0 years. According to postoperative platelet status, the patients were divided into a thrombocytopenia group and a non-thrombocytopenia group. The clinical baseline data, preoperative platelet count, postoperative minimum platelet count, volume of drainage, transfusion of blood products, mechanical ventilator time, ICU stay, hospital stay and complications were compared between the two groups.Results The mean preoperative platelet count was 199×10⁹/L±55×10⁹/L and the mean postoperative platelet nadir was 109×10⁹/L±37×10⁹/L, with a mean reduction rate of 44.1%±15.8%. The platelet count of 235 (97.9%) patients after operation was lower than that before operation. Among them, 98 (40.8%) patients had platelet count<100×10⁹/L, 46 (19.2%)<75×10⁹/L and 8 (3.3%)<50×10⁹/L. Results of multivariable logistic analysis showed that cardiopulmonary bypass time>120 min (OR=2.576, 95%CI 1.313-5.053, P<0.05) was an independent risk factor for postoperative thrombocytopenia. Mechanical ventilator time (25.5±16.8 h vs. 17.3±8.5 h, P<0.05), ICU stay (85.2±54.7 h vs. 60.0±33.9 h, P<0.05) and hospital stay (15.8±6.2 d vs. 14.2±3.9 d, P<0.05) were longer in the thrombocytopenia group (<100×10⁹/L) compared with the non-thrombocytopenia group (>100×10⁹/L). More drainage volume [685 (510, 930) mL vs. 560 (440, 790) mL, P<0.05] and complications occurred in the thrombocytopenia group. In multivariable analysis, thrombocytopenia was significantly inversely associated with prolonged ICU stay (OR=2.993, 95%CI 1.622-5.524, P<0.05).Conclusion Thrombocytopenia occurs commonly after adult cardiac surgery, and the incidence in different types of surgery varies. Postoperative thrombocytopenia is related to the prolonged recovery. Extracorporeal circulation may be a contributing factor to thrombocytopenia, and further studies investigating mechanism and strategies to reduce postoperative thrombocytopenia are needed.

Citation： LIU Zina, CHANG Shuo, LIU Na, LIU Ping, SUN Hansong. Status and clinical significance of thrombocytopenia after cardiac surgery in adults. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 350-355. doi: 10.7507/1007-4848.202009079 Copy

1.	Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets, 2015, 26(4): 286-292.
2.	Vincent JL, Castro P, Hunt BJ, et al. Thrombocytopenia in the ICU: Disseminated intravascular coagulation and thrombotic microangiopathies—What intensivists need to know. Crit Care, 2018, 22(1): 158.
3.	Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: The past, present, and future. Hematology Am Soc Hematol Educ Program, 2017, 2017(1): 660-666.
4.	Akca S, Haji-Michael P, de Mendon?a A, et al. Time course of platelet counts in critically ill patients. Crit Care Med, 2002, 30(4): 753-756.
5.	Ali N, Auerbach HE. New-onset acute thrombocytopenia in hospitalized patients: Pathophysiology and diagnostic approach. J Community Hosp Intern Med Perspect, 2017, 7(3): 157-167.
6.	Solis RT, Kennedy PS, Beall AC, et al. Cardiopulmonary bypass. Microembolization and platelet aggregation. Circulation, 1975, 52(1): 103-108.
7.	Griffin BR, Bronsert M, Reece TB, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg, 2020, 110(1): 50-57.
8.	Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Paediatr Anaesth, 2017, 27(3): 305-313.
9.	全軍重癥醫學專業委員會, 中華醫學會檢驗醫學分會. 中國成人重癥患者血小板減少診療專家共識. 解放軍醫學雜志, 2020, 45(5): 457-474.
10.	許俊堂, 李為民, 門劍龍. 肝素誘導的血小板減少癥中國專家共識(2017). 中華醫學雜志, 2018, 98(6): 408-417.
11.	Kertai MD, Zhou S, Karhausen JA, et al. Platelet counts, acute kidney injury, and mortality after coronary artery bypass grafting surgery. Anesthesiology, 2016, 124(2): 339-352.
12.	楊霄, 楊再珍, 楊霞, 等. 心臟瓣膜置換術后血小板減少的發生規律和影響. 心肺血管病雜志, 2017, 36(9): 762-765.
13.	Aguayo E, Sanaiha Y, Seo YJ, et al. Heparin-induced thrombocytopenia in cardiac surgery: Incidence, costs, and duration of stay. Surgery, 2018, 164(6): 1377-1381.
14.	Hamid M, Akhtar MI, Naqvi HI, et al. Incidence and pattern of thrombocytopenia in cardiac surgery patients. J Pak Med Assoc, 2017, 67(7): 1019-1023.
15.	Agarwal S, Johnson RI, Kirmani BH. Pre- and post-bypass platelet function testing with multiple electrode aggregometry and TEG platelet mapping in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1272-1276.
16.	Karhausen JA, Smeltz AM, Akushevich I, et al. Platelet counts and postoperative stroke after coronary artery bypass grafting surgery. Anesth Analg, 2017, 125(4): 1129-1139.

1. Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets, 2015, 26(4): 286-292.
2. Vincent JL, Castro P, Hunt BJ, et al. Thrombocytopenia in the ICU: Disseminated intravascular coagulation and thrombotic microangiopathies—What intensivists need to know. Crit Care, 2018, 22(1): 158.
3. Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: The past, present, and future. Hematology Am Soc Hematol Educ Program, 2017, 2017(1): 660-666.
4. Akca S, Haji-Michael P, de Mendon?a A, et al. Time course of platelet counts in critically ill patients. Crit Care Med, 2002, 30(4): 753-756.
5. Ali N, Auerbach HE. New-onset acute thrombocytopenia in hospitalized patients: Pathophysiology and diagnostic approach. J Community Hosp Intern Med Perspect, 2017, 7(3): 157-167.
6. Solis RT, Kennedy PS, Beall AC, et al. Cardiopulmonary bypass. Microembolization and platelet aggregation. Circulation, 1975, 52(1): 103-108.
7. Griffin BR, Bronsert M, Reece TB, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg, 2020, 110(1): 50-57.
8. Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Paediatr Anaesth, 2017, 27(3): 305-313.
9. 全軍重癥醫學專業委員會, 中華醫學會檢驗醫學分會. 中國成人重癥患者血小板減少診療專家共識. 解放軍醫學雜志, 2020, 45(5): 457-474.
10. 許俊堂, 李為民, 門劍龍. 肝素誘導的血小板減少癥中國專家共識(2017). 中華醫學雜志, 2018, 98(6): 408-417.
11. Kertai MD, Zhou S, Karhausen JA, et al. Platelet counts, acute kidney injury, and mortality after coronary artery bypass grafting surgery. Anesthesiology, 2016, 124(2): 339-352.
12. 楊霄, 楊再珍, 楊霞, 等. 心臟瓣膜置換術后血小板減少的發生規律和影響. 心肺血管病雜志, 2017, 36(9): 762-765.
13. Aguayo E, Sanaiha Y, Seo YJ, et al. Heparin-induced thrombocytopenia in cardiac surgery: Incidence, costs, and duration of stay. Surgery, 2018, 164(6): 1377-1381.
14. Hamid M, Akhtar MI, Naqvi HI, et al. Incidence and pattern of thrombocytopenia in cardiac surgery patients. J Pak Med Assoc, 2017, 67(7): 1019-1023.
15. Agarwal S, Johnson RI, Kirmani BH. Pre- and post-bypass platelet function testing with multiple electrode aggregometry and TEG platelet mapping in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1272-1276.
16. Karhausen JA, Smeltz AM, Akushevich I, et al. Platelet counts and postoperative stroke after coronary artery bypass grafting surgery. Anesth Analg, 2017, 125(4): 1129-1139.

Previous Article
Surgical treatment for aortic periannular abscess
Next Article
Effect of different skin closure techniques on postoperative complications of stoma reversal：a network meta-analysis

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Status and clinical significance of thrombocytopenia after cardiac surgery in adults

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content