Routine transfusion of platelet concentrates effectively reduces reoperation rate for bleeding and pericardial effusion after elective operations for ascending aortic aneurysm

Abstract

Patients with ascending aortic aneurysm undergoing complex surgical procedures are at increased risk of early postoperative excessive blood loss. The aim of this study was to analyze safety and efficacy of routine transfusions of platelet (PLT) concentrates in reduction of hemorrhagic postoperative complications. The study involved 396 consecutive patients (289 males and 107 females) with the mean age of 55.9 ± 13.6 years who underwent elective operations for aortic aneurysms. They were divided retrospectively into two groups, without (group A; n = 123) or with the routine use of PLTs (group B; n = 273). PLTs were transfused intraoperatively just after completion of cardiopulmonary bypass. Twelve patients in group A (9.8%) and 10 (3.7%) in group B required re-thoracotomy due to hemorrhage (p = 0.027). Routine transfusions of PLT concentrates reduced postoperative incidence of excessive pericardial effusion from 24.1% in group A to 2.1% in group B (p = 0.002). In a consequence, significantly less units (p < 0.0001) of red blood concentrates and fresh frozen plasma were transfused in group B than in group A. The rates of other adverse events in the early postoperative period did not differ between groups. Patients with pericardial effusion required 6.3 ± 2.7 additional days of hospitalization due to surgical re-intervention. Neither blood transfusion-related infections nor adverse reactions were noted. In conclusion, routine intraoperative transfusions of PLT concentrates in patients with ascending aortic aneurysms significantly reduced a need for re-intervention due to both early bleeding and late cardiac tamponade.

Re-exploration Early after Cardiac Surgery in Adults: The Importance of Bleeding-Related Complications

“…Although coagulation diagnostics and management have improved over the years, perioperative bleeding is still a significant problem in cardiac surgery [Ghavidel 2015;Colson 2016;Perek 2016]. Bleeding tendency is probably inevitable these days, as recommendations of the latest guidelines, for example, advise operating while patients are on aspirin, and the growing use of novel oral anticoagulants that do not demand regular screening obfuscates the issue [Windecker 2014;Heidbuchel 2015].…”

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

“…The AABB suggests platelet transfusion for patients having CPB who exhibit perioperative bleeding with thrombocytopenia and/or with evidence of platelet dysfunction.” . Conversely, Perek et al showed that routine transfusion of platelets to patients undergoing elective operations for ascending aortic aneurysm decreased risk of re‐intervention due to bleeding …”

Modifiable Risk Factors associated with Post-Operative Bleeding and transfusion requirements in Cardiac Surgery

“…Hence, platelet function defect and thrombocytopenia are commonly treated with transfusions of platelet in patients undergoing CPB. 33 Recently reported study on 177 patients observed thrombocytopenia in 167(94.4%) patients from the baseline value. There was maximum drop in platelet count during 2nd and 3rd postoperative days.…”