Status and clinical significance of thrombocytopenia after cardiac surgery in adults_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zina ¹ , CHANG Shuo ¹ , LIU Na ² , LIU Ping ¹ ,  SUN Hansong ¹

1. Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Blood Transfusion, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

SUN Hansong, Email: drsunhs@sina.com

Keywords：

Cardiac surgery; thrombocytopenia; postoperative recovery

DOI：

10.7507/1007-4848.202009079

Video：

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Objective To observe the status of thrombocytopenia in adult patients after cardiac surgery, and to explore its mechanism and clinical significance.Methods Retrospective analysis of 240 patients after cardiac surgery in the 2^nd ward of surgical intensive care unit (ICU) of Fuwai Hospital from May to June 2020 was conducted, including 137 males and 103 females with a mean age of 56.0±12.0 years. According to postoperative platelet status, the patients were divided into a thrombocytopenia group and a non-thrombocytopenia group. The clinical baseline data, preoperative platelet count, postoperative minimum platelet count, volume of drainage, transfusion of blood products, mechanical ventilator time, ICU stay, hospital stay and complications were compared between the two groups.Results The mean preoperative platelet count was 199×10⁹/L±55×10⁹/L and the mean postoperative platelet nadir was 109×10⁹/L±37×10⁹/L, with a mean reduction rate of 44.1%±15.8%. The platelet count of 235 (97.9%) patients after operation was lower than that before operation. Among them, 98 (40.8%) patients had platelet count<100×10⁹/L, 46 (19.2%)<75×10⁹/L and 8 (3.3%)<50×10⁹/L. Results of multivariable logistic analysis showed that cardiopulmonary bypass time>120 min (OR=2.576, 95%CI 1.313-5.053, P<0.05) was an independent risk factor for postoperative thrombocytopenia. Mechanical ventilator time (25.5±16.8 h vs. 17.3±8.5 h, P<0.05), ICU stay (85.2±54.7 h vs. 60.0±33.9 h, P<0.05) and hospital stay (15.8±6.2 d vs. 14.2±3.9 d, P<0.05) were longer in the thrombocytopenia group (<100×10⁹/L) compared with the non-thrombocytopenia group (>100×10⁹/L). More drainage volume [685 (510, 930) mL vs. 560 (440, 790) mL, P<0.05] and complications occurred in the thrombocytopenia group. In multivariable analysis, thrombocytopenia was significantly inversely associated with prolonged ICU stay (OR=2.993, 95%CI 1.622-5.524, P<0.05).Conclusion Thrombocytopenia occurs commonly after adult cardiac surgery, and the incidence in different types of surgery varies. Postoperative thrombocytopenia is related to the prolonged recovery. Extracorporeal circulation may be a contributing factor to thrombocytopenia, and further studies investigating mechanism and strategies to reduce postoperative thrombocytopenia are needed.

Citation： LIU Zina, CHANG Shuo, LIU Na, LIU Ping, SUN Hansong. Status and clinical significance of thrombocytopenia after cardiac surgery in adults. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 350-355. doi: 10.7507/1007-4848.202009079 Copy

1.	Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets, 2015, 26(4): 286-292.
2.	Vincent JL, Castro P, Hunt BJ, et al. Thrombocytopenia in the ICU: Disseminated intravascular coagulation and thrombotic microangiopathies—What intensivists need to know. Crit Care, 2018, 22(1): 158.
3.	Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: The past, present, and future. Hematology Am Soc Hematol Educ Program, 2017, 2017(1): 660-666.
4.	Akca S, Haji-Michael P, de Mendonça A, et al. Time course of platelet counts in critically ill patients. Crit Care Med, 2002, 30(4): 753-756.
5.	Ali N, Auerbach HE. New-onset acute thrombocytopenia in hospitalized patients: Pathophysiology and diagnostic approach. J Community Hosp Intern Med Perspect, 2017, 7(3): 157-167.
6.	Solis RT, Kennedy PS, Beall AC, et al. Cardiopulmonary bypass. Microembolization and platelet aggregation. Circulation, 1975, 52(1): 103-108.
7.	Griffin BR, Bronsert M, Reece TB, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg, 2020, 110(1): 50-57.
8.	Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Paediatr Anaesth, 2017, 27(3): 305-313.
9.	全军重症医学专业委员会, 中华医学会检验医学分会. 中国成人重症患者血小板减少诊疗专家共识. 解放军医学杂志, 2020, 45(5): 457-474.
10.	许俊堂, 李为民, 门剑龙. 肝素诱导的血小板减少症中国专家共识(2017). 中华医学杂志, 2018, 98(6): 408-417.
11.	Kertai MD, Zhou S, Karhausen JA, et al. Platelet counts, acute kidney injury, and mortality after coronary artery bypass grafting surgery. Anesthesiology, 2016, 124(2): 339-352.
12.	杨霄, 杨再珍, 杨霞, 等. 心脏瓣膜置换术后血小板减少的发生规律和影响. 心肺血管病杂志, 2017, 36(9): 762-765.
13.	Aguayo E, Sanaiha Y, Seo YJ, et al. Heparin-induced thrombocytopenia in cardiac surgery: Incidence, costs, and duration of stay. Surgery, 2018, 164(6): 1377-1381.
14.	Hamid M, Akhtar MI, Naqvi HI, et al. Incidence and pattern of thrombocytopenia in cardiac surgery patients. J Pak Med Assoc, 2017, 67(7): 1019-1023.
15.	Agarwal S, Johnson RI, Kirmani BH. Pre- and post-bypass platelet function testing with multiple electrode aggregometry and TEG platelet mapping in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1272-1276.
16.	Karhausen JA, Smeltz AM, Akushevich I, et al. Platelet counts and postoperative stroke after coronary artery bypass grafting surgery. Anesth Analg, 2017, 125(4): 1129-1139.

1. Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets, 2015, 26(4): 286-292.
2. Vincent JL, Castro P, Hunt BJ, et al. Thrombocytopenia in the ICU: Disseminated intravascular coagulation and thrombotic microangiopathies—What intensivists need to know. Crit Care, 2018, 22(1): 158.
3. Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: The past, present, and future. Hematology Am Soc Hematol Educ Program, 2017, 2017(1): 660-666.
4. Akca S, Haji-Michael P, de Mendonça A, et al. Time course of platelet counts in critically ill patients. Crit Care Med, 2002, 30(4): 753-756.
5. Ali N, Auerbach HE. New-onset acute thrombocytopenia in hospitalized patients: Pathophysiology and diagnostic approach. J Community Hosp Intern Med Perspect, 2017, 7(3): 157-167.
6. Solis RT, Kennedy PS, Beall AC, et al. Cardiopulmonary bypass. Microembolization and platelet aggregation. Circulation, 1975, 52(1): 103-108.
7. Griffin BR, Bronsert M, Reece TB, et al. Thrombocytopenia after cardiopulmonary bypass is associated with increased morbidity and mortality. Ann Thorac Surg, 2020, 110(1): 50-57.
8. Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery. Paediatr Anaesth, 2017, 27(3): 305-313.
9. 全军重症医学专业委员会, 中华医学会检验医学分会. 中国成人重症患者血小板减少诊疗专家共识. 解放军医学杂志, 2020, 45(5): 457-474.
10. 许俊堂, 李为民, 门剑龙. 肝素诱导的血小板减少症中国专家共识(2017). 中华医学杂志, 2018, 98(6): 408-417.
11. Kertai MD, Zhou S, Karhausen JA, et al. Platelet counts, acute kidney injury, and mortality after coronary artery bypass grafting surgery. Anesthesiology, 2016, 124(2): 339-352.
12. 杨霄, 杨再珍, 杨霞, 等. 心脏瓣膜置换术后血小板减少的发生规律和影响. 心肺血管病杂志, 2017, 36(9): 762-765.
13. Aguayo E, Sanaiha Y, Seo YJ, et al. Heparin-induced thrombocytopenia in cardiac surgery: Incidence, costs, and duration of stay. Surgery, 2018, 164(6): 1377-1381.
14. Hamid M, Akhtar MI, Naqvi HI, et al. Incidence and pattern of thrombocytopenia in cardiac surgery patients. J Pak Med Assoc, 2017, 67(7): 1019-1023.
15. Agarwal S, Johnson RI, Kirmani BH. Pre- and post-bypass platelet function testing with multiple electrode aggregometry and TEG platelet mapping in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5): 1272-1276.
16. Karhausen JA, Smeltz AM, Akushevich I, et al. Platelet counts and postoperative stroke after coronary artery bypass grafting surgery. Anesth Analg, 2017, 125(4): 1129-1139.

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