Background
Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke.
Methods
We evaluated 6,130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild vs. moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0–1 days; delayed: ≥2 days).
Results
Median [interquartile range] postoperative nadir platelet counts were 123.0 [98.0, 155.0] × 109/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts, >150×109/L, 100–150×109/L, and <100×109/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 109/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01–1.24; P=0.0255). On a given day, patients with moderate to severe thrombocytopenia were twice as likely to develop stroke (adjusted HR, 1.99; 95% CI, 1.18–3.34; P=0.0093) as patients with nadir platelet counts >150×109/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2days after surgery; adjusted HR, 2.87; 95% CI, 1.49–5.55; P=0.0016), but not early postoperative stroke.
Conclusion
Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.