University of Oulu

Wail Nammas, Magnus Dalén, Stefano Rosato, Riccardo Gherli, Daniel Reichart, Giuseppe Gatti, Francesco Onorati, Giuseppe Faggian, Marisa De Feo, Ciro Bancone, Sidney Chocron, Sorosh Khodabandeh, Giuseppe Santarpino, Antonino S. Rubino, Daniele Maselli, Saverio Nardella, Antonio Salsano, Tiziano Gherli, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Karl Bounader, Paola D’Errigo, Tuomas Kiviniemi, Eeva-Maija Kinnunen, Andrea Perrotti, Juhani Airaksinen, Giovanni Mariscalco, Vito G. Ruggieri & Fausto Biancari (2019) Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting, Platelets, 30:4, 480-486, DOI: 10.1080/09537104.2018.1466389

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

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Author: Nammas, Wail1; Dalén, Magnus2; Rosato, Stefano3;
Organizations: 1Heart Center, Turku University Hospital, University of Turku, Turku, Finland
2Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
3National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy
4Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
5Hamburg University Heart Center, Hamburg, Germany
6Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
7Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
8Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
9Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
10Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Città di Lecce Hospital GVM Care&Research, Lecce, Italy
11Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy;
12Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
13Division of Cardiac Surgery, University of Genoa, Genoa, Italy
14Division of Cardiac Surgery, University of Parma, Parma, Italy
15Department of Cardiac Surgery, Centro Cardiologico – Fondazione Monzino IRCCS, University of Milan
16Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
17Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
18Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France;
19Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
20Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
21Department of Surgery, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2019102234173
Language: English
Published: Informa, 2019
Publish Date: 2019-10-22
Description:

Abstract

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 × 10⁹/L and it was considered moderate-severe when preoperative platelet count was <100 × 10⁹/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.

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Series: Platelets
ISSN: 0953-7104
ISSN-E: 1369-1635
ISSN-L: 0953-7104
Volume: 30
Issue: 4
Pages: 480 - 486
DOI: 10.1080/09537104.2018.1466389
OADOI: https://oadoi.org/10.1080/09537104.2018.1466389
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © Taylor & Francis 2018. This is an Accepted Manuscript of an article published by Taylor & Francis in Platelets on 20.4.2018, available online: http://www.tandfonline.com/10.1080/09537104.2018.1466389.