Treatment Strategy and Perioperative Risk in Patients with Idiopathic Thrombocytopenic Purpura Undergoing Cardiac Surgery

Abstract

Patients suffering from idiopathic thrombocytopenic purpura undergoing cardiac surgery with extracorporeal circulation may be at increased risk for postoperative bleeding complications. Therefore, different treatment strategies, such as conservative treatment, splenectomy, transfusion of platelet concentrates and therapy with immunoglobulins have been proposed. We report on our experiences with preoperative immunoglobulin treatment in selected patients with special regard on the optimal dosage.

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

“…Thrombocytopenia has been studied in various cardiovascular procedures and is associated with a higher incidence of adverse outcomes, increased mortality rate, and higher health care costs [5,6]. Patients with ITP who undergo cardiac surgery with extracorporeal circulation have an increased risk of postoperative bleeding, postoperative infection, acute kidney injury, and mortality [7][8][9]. The use of cardiopulmonary bypass (CPB) is also known to decrease platelet count by 25-45% compared to preoperative levels due to inflammatory response to CPB, hemodilution, hypothermia, mechanical damage, and pharmacological treatment (heparin and protamine) [7][8][9][10][11][12].…”

“…Patients with ITP who undergo cardiac surgery with extracorporeal circulation have an increased risk of postoperative bleeding, postoperative infection, acute kidney injury, and mortality [7][8][9]. The use of cardiopulmonary bypass (CPB) is also known to decrease platelet count by 25-45% compared to preoperative levels due to inflammatory response to CPB, hemodilution, hypothermia, mechanical damage, and pharmacological treatment (heparin and protamine) [7][8][9][10][11][12]. Platelet counts tend to decrease 48-72 hours after CPB use, increasing the risk of more decrease due to sepsis, post-transfusion thrombocytopenia, or drug-induced or thrombotic thrombocytopenic purpura [8][9][10][11].…”

“…The use of cardiopulmonary bypass (CPB) is also known to decrease platelet count by 25-45% compared to preoperative levels due to inflammatory response to CPB, hemodilution, hypothermia, mechanical damage, and pharmacological treatment (heparin and protamine) [7][8][9][10][11][12]. Platelet counts tend to decrease 48-72 hours after CPB use, increasing the risk of more decrease due to sepsis, post-transfusion thrombocytopenia, or drug-induced or thrombotic thrombocytopenic purpura [8][9][10][11]. Serial platelet monitoring is crucial, especially for patients with a coagulation disorder [7].…”