Does a Platelet Transfusion Independently Affect Bleeding and Adverse Outcomes in Cardiac Surgery?

Abstract

Background Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients. Methods For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1:3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified. Results The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However, patients in the intervention group experienced less blood loss and required vasoactive medication 139 of 169 (82%) versus 370 of 507 (74%; odds ratio, 1.65; 95% CI, 1.05 to 2.58), prolonged mechanical ventilation 92 of 169 (54%) versus 226 of 507 (45%; odds ratio, 1.47; 94% CI, 1.03 to 2.11), prolonged intensive care 95 of 169 (56%) versus 240 of 507 (46%; odds ratio, 1.49; 95% CI, 1.04 to 2.12), erythrocytes 75 of 169 (44%) versus 145 of 507 (34%; odds ratio, 1.55; 95% CI, 1.08 to 2.23), plasma 29 of 169 (17%) versus 23 of 507 (7.3%; odds ratio, 2.63; 95% CI, 1.50–4.63), and platelets 72 of 169 (43%) versus 25 of 507 (4.3%; odds ratio, 16.4; 95% CI, 9.3–28.9) more often compared to the reference group. Conclusions In this retrospective analysis, cardiac surgery patients receiving platelet transfusion in the operating room experienced less blood loss and more often required vasoactive medication, prolonged ventilation, prolonged intensive care, and blood products postoperatively. However, early platelet transfusion was not associated with reinterventions, thromboembolic complications, infections, organ failure, or mortality.

Platelet Transfusion in Perioperative Medicine

“…69 Observational studies found an association between platelet transfusions and thrombotic complications in critically ill patients, 70,71 whereas no association was found in patients undergoing cardiac surgery. 72 Due to their design and inability to control for confounders, these studies cannot establish a causal relationship. Of note, the risk of coronary thrombosis could be higher if platelet transfusions are given in patients on antiplatelet therapy due to recent cardiac stenting.…”

“…10 Van Hout evaluated 23,860 cardiac surgery patients and found that patients receiving platelet transfusion in the operating room experienced less blood loss but more often required vasoactive medication, prolonged ventilation, prolonged intensive care, and blood products postoperatively. 72 A therapeutic platelet transfusion approach is probably more appropriate than a prophylactic approach. Platelets may preferentially be transfused after separation from cardiopulmonary bypass after reversal of heparin, a time point when adequate hemostasis is required.…”

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

“…12 As shown by Levy et al (2017), 13 there is still no consensus in the literature regarding triggers for platelet transfusion. Van Hout et al 14 reported that early platelet transfusions were associated with less postoperative blood loss but increased the risk for use of vasoactive drugs and extended mechanical ventilation, as well as prolonged stay in the intensive care unit (ICU). Several adverse events, including allergic reactions, infection and stroke, have been related to platelet transfusion.…”

Platelet Count and Function—Can We Kill Two Birds With an Ultrasound Wave?

“…Perioperative platelet transfusion commonly is administered to patients after CPB based on the assumption that platelets are either damaged by CPB or lost in the surgical field. 12 Perhaps knowing more about platelet function would lead to a more rational use of platelet transfusion. However, in 1 retrospective propensity score-matched study, implementation of platelet function testing was shown to increase the use of desmopressin acetate without clear improvement in bleeding.…”