Status and clinical significance of thrombocytopenia after cardiac surgery in adults / 中国胸心血管外科临床杂志

ABSTRACT

@#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 2nd 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.