The rationale for platelet transfusion during cardiopulmonary bypass: an observational study

Abstract

Purpose Platelet transfusion in cardiac surgery is often empiric as no established point-of-care tests are available for clear guidance of blood product administration, and there are many variables that can potentially increase the risk of bleeding during cardiopulmonary bypass. The objectives of this study were to determine the factors that influenced physicians' decisions to transfuse platelets perioperatively and to determine whether these factors coincide with characteristics using chart abstraction.Methods This study was conducted at three university affiliated hospitals using focused physician questionnaires to assess factors influencing decisions to transfuse platelets and data abstraction to determine characteristics of patients receiving platelet transfusion during cardiac surgery. Results Seventy-six physicians participated in the questionnaire; 41% identified bleeding and 22% identified both bleeding and the platelet count as the most significant factors influencing their decision to transfuse platelets. Of the 629 patients included in the study, 24.5% received a platelet transfusion intraoperatively and 4.5% received the transfusion postoperatively. The following factors were identified with the highest odds of receiving a platelet transfusion intraoperatively: combined bypass and valvular surgery (odds ratio [OR] 3.94; 95% confidence interval [CI] 1.94 to 8.00) and the presence of liver disease (OR 6.43; 95% CI 1.17 to 35.37). Conclusion The use of focused physician questionnaires identified relevant aspects of patient care not apparent in the chart review that influenced the decision to transfuse platelets. The identification of bleeding, thrombocytopenia, more complex surgery, and the presence of liver disease Author contributions Nusrat Zaffar, Ashley Joseph, Katerina Pavenski, Jeannie Callum, and Christine Cserti-Gazdewich contributed to the acquisition of data. Nusrat Zaffar, Ashley Joseph, Rosane Nisenbaum, and Nadine Shehata contributed to the analysis of data. Nusrat Zaffar, Ashley Joseph, and Nadine Shehata contributed to drafting the manuscript. Nusrat Zaffar, Ashley Joseph C. David Mazer, Rosane Nisenbaum Keyvan Karkouti, Alan Tinmouth, Mark Peterson, Katerina Pavenski, Jeannie Callum, Christine Cserti-Gazdewich, and Nadine Shehata contributed to the revision of the manuscript. C. David Mazer and Nadine Shehata contributed to the conception of the study. C. David Mazer, Keyvan Karkouti, Alan Tinmouth, Mark Peterson, Katerina Pavenski, Jeannie Callum, Christine Cserti-Gazdewich, and Nadine Shehata contributed to the design and the interpretation of the data. highlights the requirement for standardized measures to assess the need for platelet transfusions in bleeding patients. RésuméObjectif En chirurgie cardiaque, la transfusion de plaquettes se fait souvent de façon empirique; en effet, aucun test reconnu n'est disponible au chevet du malade afin de guider clairement l'administration de produits sanguins. En outre, il existe de nombreuses variables qui peuvent potentiellement aug...

Changing trends in blood transfusion: an analysis of 244,013 hospitalizations

“…The hematology‐oncology, stem cell transplantation, and cardiac surgery services were the predominant users of PLT transfusion. Whereas for the hematology‐oncology and stem cell transplantation services, the indications for PLT transfusion have been well defined,22‐24 more data are still required to identify critical thresholds for transfusion of PLTs in the cardiac surgery population, as the proportion of admissions receiving PLT transfusion has increased and it is unclear whether PLT transfusion is associated with increased morbidity and mortality …”

“…still required to identify critical thresholds for transfusion of PLTs in the cardiac surgery population, 25 as the proportion of admissions receiving PLT transfusion has increased and it is unclear whether PLT transfusion is associated with increased morbidity and mortality. 26,27 There are a few limitations to this study.…”

Effects of circuit albumin coating on coagulation and inflammatory response for patients receiving aortic arch replacement: a randomized controlled trial

“…Our results also illustrate that the platelet count was of limited value as an indication for platelet transfusion as the low number of platelets didn't necessarily imply platelet dysfunction. 19 Cardiopulmonary bypass is a non-physiological circulation for cardiac surgery patients. 7 The inflammatory reaction is primarily caused by cytokines and complement system activation when blood cells contact the foreign surface of the extracorporeal circuit.…”

Variation in transfusion rates within a single institution: Exploring the effect of differing practice patterns on the likelihood of blood product transfusion in patients undergoing cardiac surgery

“…Second, the effect of case volume, level of experience, or location of residency and/or fellowship training on the likelihood of an individual surgeon or anesthesiologist choosing transfusion was not examined. Third, the amount of perioperative bleeding, which has been shown to affect the decision on transfusion, 19 was not recorded. Fourth, the retrospective nature of this study did not allow us to determine who was responsible for deciding on transfusion or not and what the reason for the transfusion was.…”

“…However, for the purposes of this study, not knowing who initiated the transfusion and why impeded our ability to explain the interpractitioner variability observed. Recently, Zaffar and colleagues 19 published a study in which focused physician questionnaires were administered to assess factors influencing the decision to transfuse platelets during cardiac surgery. The respondents reported bleeding, bleeding in the presence of thrombocytopenia, type of surgical procedure, and preoperative antiplatelet use as significant factors.…”