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
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Publish Date: | 2019-10-22 |
Description: |
AbstractThe 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. see all
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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. |