Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis

Yanagawa, Bobby; Ribeiro, Roberto Vanin Pinto; Lee, Jessica; Mazer, C. David; Cheng, Davy; Martin, Janet; Verma, Subodh; Friedrich, Jan O.

doi:10.1016/j.athoracsur.2020.04.139

Cited by 16 publications

(6 citation statements)

References 27 publications

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“…Prevalence of platelet dysfunction and thrombocytopenia have increased in patients with cardiac surgery due to the widespread application of potent antiplatelet agents ( 3 ). Transfusing platelet directly is an effective treatment for decreasing coagulation.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggested that although blood transfusion tended to bring patients benefits during the operation, risks and costs were also associated. Several studies have separately discussed the association between the outcome of cardiac surgery and blood transfusion components, such as platelet and plasma ( 3 , 4 ). However, the impact of the blood transfusion on the prognosis of HTx is still lacking.…”

Section: Introductionmentioning

confidence: 99%

The Predictive Role of Intraoperative Blood Transfusion Components in the Prognosis of Heart Transplantation

Zheng,

Xu,

Cai

et al. 2022

Front. Cardiovasc. Med.Has correction 2022-8-18 Has erratum 2022-8-18

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PurposeTo evaluate the influence of transfusion amount of blood components on the prognosis of patients after heart transplantation (HTx).MethodsFrom 1 January 2015 to 31 December 2020, 568 patients underwent HTx in our institute. A total of 416 recipients with complete datasets were enrolled in the study for final statistical analysis according to the inclusion criteria. The optimal cut-off values for intraoperative transfusion of red blood cell (RBC), platelet, and plasma were determined with receiver operating curve analysis. Univariate and multivariate Cox regression analyses were applied to compare baseline data of patients divided by the transfusion amounts of RBC, platelet, and plasma. Propensity score matching was used to enable the direct comparison of outcomes.ResultsThe Kaplan–Meier analysis revealed that transfusion amounts of RBC and plasma were independently associated with overall mortality, increased intensive care unit stay time, and major adverse events after transplantation. The multivariate Cox regression analysis suggested that neurological complications (p = 0.001), liver damage (p = 0.011), and respiratory complications (p = 0.044) were independent risk factors for overall mortality after HTx. Combining indicators presented a good predicting effect of peritransplant period mortality (AUC = 0.718).ConclusionThe mortality of HTx was significantly related to the high-amount transfusion of RBC and plasma. Comprehensively considering the components of blood transfusion obtained better predictive results of peritransplant period survival than solely considering a single component.

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“…We have described the variability of platelet transfusion practices at our center previously 21,22 . It is important to highlight that cardiac surgery patients formed the largest subgroup in this study and hemostasis is particularly complex in this population due to hemodilution, extracorporeal circulation, coagulopathy/hyperfibrinolysis, and frequent use of antiplatelet agents 23 . Regardless of whether non‐inferiority was demonstrated for the individual analyses, the absolute count increments following transfusion consistently trended lower in the 7‐day platelet period for all patients and subgroups compared to the 5‐day platelet period; this trend is likely driven by prolonged platelet storage duration as shown in our secondary analyses which analyzed count increments by storage duration alone.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the clinical impacts of 7‐day platelets

Ning

Gabarin

et al. 2023

Transfusion

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Background: In August 2017, Canadian Blood Services extended the shelf-life of platelet concentrates from 5 to 7 days. The clinical impacts of this policy change remain unclear.Study Design and Methods: We used a before-after retrospective design of platelet-transfused adult inpatients in Hamilton, ON, Canada. Data were captured for 18 months before (Period 1: February 2016-July 2017) and 18 months after (Period 2: September 2017-February 2019) 7-day platelet implementation.Primary outcome was absolute platelet count increment (ACI) in univariate and multivariate analyses adjusted for confounders. Data were obtained from our institution's transfusion database, Ontario's Transfusion Transmitted Injuries Surveillance System, and the blood supplier. Results: Overall, 1360 patients with single dose platelet transfusions were included in Period 1 and 1211 patients in Period 2. Median age at admission was 66 years, and approximately 40% of patients underwent cardiac surgery. Using a non-inferiority margin of À10 Â 10 9 /L, platelets transfused during the 7-day storage period were non-inferior to those transfused in the 5-day storage period [mean count difference À 4.63 Â 10 9 /L (95% CI À7.40 to À1.87, p = 0.0001)].However, platelet ACIs following transfusion consistently trended lower in the 7-day group for all patients and subgroups. No differences in secondary clinical outcomes were observed. Platelet expiry reduced from 8.1 to 6.3% (p < 0.0001). Conclusion:Platelet transfusions following 7-day storage policy were noninferior to transfusions in the 5-day policy period, although reduced ACIs were observed. There were no increases in adverse clinical outcomes.Platelets are a valuable, life-saving blood product transfused to prevent or treat bleeding. The duration of storage of platelets varies across countries. Some countries employ a short storage time, with a platelet shelf life of

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“…3 Although preoperative hypercoagulability is common in infective endocarditis, surgery may be cumbersome due to involvement of multiple valves and/or abscess formation, leading to long CPB time, which in itself is associated with increased need of blood transfusion, bleeding, and coagulation disorders. 105,106 Some studies showed an increased incidence of massive blood transfusion, 107,108 transfusion of platelets, 109,110 or postoperative active bleeding 111 in patients with infective endocarditis.…”

Section: Bleeding and Transfusionmentioning

confidence: 99%

Anesthesia Considerations in Infective Endocarditis

Hermanns¹,

Eberl

Terwindt³

et al. 2022

Anesthesiology

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The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

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“…Of the 37,000 adults undergoing cardiac surgery annually in Britain, those suffering postoperative complications [ 5 ] have prolonged intensive care and hospitalization, higher 30-day readmission, and higher mortality [ 6 , 7 ]. Approximately 20% of patients readmitted within 30 days after cardiac surgery [ 8 ] are at risk of higher rates of mortality, stroke, and cardiac transplantation than the general population [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac surgery receipt and outcomes for people using secondary mental healthcare services: Retrospective cohort study using a large mental healthcare database in South London

et al. 2022

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Background.Patients with diagnosed mental health problems are more predisposed to cardiovascular disease, including cardiac surgery. Nevertheless, health outcomes after cardiac surgery for patients with mental health problems as a discrete group are unknown. This study examined the association between secondary care mental health service use and postoperative health outcomes following cardiac surgery. Methods.We conducted a retrospective observational research, utilising data from a large South London mental healthcare supplier linked to national hospitalisation data. OPCS-4 codes were applied to classify cardiac surgery. Health results were compared between those individuals with a mental health disorder diagnosis from secondary care and other local residents, including the length of hospital stay (LOS), inpatient mortality, and 30-day emergency hospital readmission. Results.12,384 patients received cardiac surgery, including 1,481 with a mental disorder diagnosis.Patients with mental health diagnosis were at greater risk of emergency admissions for cardiac surgery (Odds ratio [

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Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 27 publications

The Predictive Role of Intraoperative Blood Transfusion Components in the Prognosis of Heart Transplantation

An evaluation of the clinical impacts of 7‐day platelets

Anesthesia Considerations in Infective Endocarditis

Cardiac surgery receipt and outcomes for people using secondary mental healthcare services: Retrospective cohort study using a large mental healthcare database in South London

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