Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting
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Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting. / Nammas, Wail; Dalén, Magnus; Rosato, Stefano; Gherli, Riccardo; Reichart, Daniel; Gatti, Giuseppe; Onorati, Francesco; Faggian, Giuseppe; De Feo, Marisa; Bancone, Ciro; Chocron, Sidney; Khodabandeh, Sorosh; Santarpino, Giuseppe; Rubino, Antonino S; Maselli, Daniele; Nardella, Saverio; Salsano, Antonio; Gherli, Tiziano; Nicolini, Francesco; Zanobini, Marco; Saccocci, Matteo; Bounader, Karl; D'Errigo, Paola; Kiviniemi, Tuomas; Kinnunen, Eeva-Maija; Perrotti, Andrea; Airaksinen, Juhani; Mariscalco, Giovanni; Ruggieri, Vito G; Biancari, Fausto.
in: PLATELETS, Jahrgang 30, Nr. 4, 2019, S. 480-486.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of preoperative thrombocytopenia on the outcome after coronary artery bypass grafting
AU - Nammas, Wail
AU - Dalén, Magnus
AU - Rosato, Stefano
AU - Gherli, Riccardo
AU - Reichart, Daniel
AU - Gatti, Giuseppe
AU - Onorati, Francesco
AU - Faggian, Giuseppe
AU - De Feo, Marisa
AU - Bancone, Ciro
AU - Chocron, Sidney
AU - Khodabandeh, Sorosh
AU - Santarpino, Giuseppe
AU - Rubino, Antonino S
AU - Maselli, Daniele
AU - Nardella, Saverio
AU - Salsano, Antonio
AU - Gherli, Tiziano
AU - Nicolini, Francesco
AU - Zanobini, Marco
AU - Saccocci, Matteo
AU - Bounader, Karl
AU - D'Errigo, Paola
AU - Kiviniemi, Tuomas
AU - Kinnunen, Eeva-Maija
AU - Perrotti, Andrea
AU - Airaksinen, Juhani
AU - Mariscalco, Giovanni
AU - Ruggieri, Vito G
AU - Biancari, Fausto
PY - 2019
Y1 - 2019
N2 - The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 109/L and it was considered moderate-severe when preoperative platelet count was <100 × 109/L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management. Among 7189 patients included in this analysis, 599 (8.3%) had preoperative thrombocytopenia. Patient with preoperative thrombocytopenia had an increased chest drainage output at 12 h (mean, 519 vs. 456 mL, adjusted coeff. 39, 95%CI 18-60) and rates of severe-massive bleeding (Universal Definition of Perioperative Bleeding (UDPB) severity grades 3-4: 12.7% vs. 8.1%, adjusted OR 1.47, 95%CI 1.11-1.93; E-CABG bleeding severity grades 2-3: 10.4% vs. 6.1%, adjusted OR 1.78, 95%CI 1.30-2.43). Thrombocytopenia was associated with an increased risk of hospital/30-day death (3.2% vs. 1.9%, adjusted OR 2.02, 95%CI 1.20-3.42), 1-year death (5.7% vs. 3.4%, adjusted HR 1.68, 95%CI 1.16-2.44), deep sternal wound infection (3.5% vs. 2.4%, adjusted OR 1.65, 95%CI 1.02-2.66), acute kidney injury (28.1% vs. 22.2%, OR 1.45, 1.18-1.78), and prolonged stay in the intensive care unit (mean, 3.6 vs 2.8 days, adjusted coeff. 0.74, 95%CI 0.40-1.09). Similar results were observed in a subset of patients with moderate-severe thrombocytopenia (51 patients, 0.7%). In particular, these patients had a markedly higher rate of acute kidney injury (40%, adjusted OR, 1.94, 95%CI 1.05-3.57), resternotomy for bleeding (7.8%, adjusted OR 3.49, 95%CI 1.20-10.21), and severe-massive bleeding (UDPB severity grades 3-4: 23.5%, adjusted OR 3.08, 95%CI 1.52-6.22; E-CABG bleeding severity grades 2-3: 23.5%, adjusted OR 4.43, 95%CI 2.15-9.15) compared to patients with normal preoperative platelet count. Mild preoperative thrombocytopenia is associated with increased risk of severe-massive bleeding, mortality, and other major adverse events after CABG. Such risks are markedly increased in patients with moderate-severe preoperative thrombocytopenia.
AB - The impact of thrombocytopenia on postoperative bleeding and other major adverse events after cardiac surgery is unclear. This issue was investigated in a series of patients who underwent isolated coronary artery bypass grafting (CABG) from the prospective, multicenter E-CABG registry. Preoperative thrombocytopenia was defined as preoperative platelet count <150 × 109/L and it was considered moderate-severe when preoperative platelet count was <100 × 109/L. Multilevel mixed-effects regression analysis was performed to adjust the effect of thrombocytopenia on outcomes for baseline and operative covariates as well as for interinstitutional differences in patient-blood management. Among 7189 patients included in this analysis, 599 (8.3%) had preoperative thrombocytopenia. Patient with preoperative thrombocytopenia had an increased chest drainage output at 12 h (mean, 519 vs. 456 mL, adjusted coeff. 39, 95%CI 18-60) and rates of severe-massive bleeding (Universal Definition of Perioperative Bleeding (UDPB) severity grades 3-4: 12.7% vs. 8.1%, adjusted OR 1.47, 95%CI 1.11-1.93; E-CABG bleeding severity grades 2-3: 10.4% vs. 6.1%, adjusted OR 1.78, 95%CI 1.30-2.43). Thrombocytopenia was associated with an increased risk of hospital/30-day death (3.2% vs. 1.9%, adjusted OR 2.02, 95%CI 1.20-3.42), 1-year death (5.7% vs. 3.4%, adjusted HR 1.68, 95%CI 1.16-2.44), deep sternal wound infection (3.5% vs. 2.4%, adjusted OR 1.65, 95%CI 1.02-2.66), acute kidney injury (28.1% vs. 22.2%, OR 1.45, 1.18-1.78), and prolonged stay in the intensive care unit (mean, 3.6 vs 2.8 days, adjusted coeff. 0.74, 95%CI 0.40-1.09). Similar results were observed in a subset of patients with moderate-severe thrombocytopenia (51 patients, 0.7%). In particular, these patients had a markedly higher rate of acute kidney injury (40%, adjusted OR, 1.94, 95%CI 1.05-3.57), resternotomy for bleeding (7.8%, adjusted OR 3.49, 95%CI 1.20-10.21), and severe-massive bleeding (UDPB severity grades 3-4: 23.5%, adjusted OR 3.08, 95%CI 1.52-6.22; E-CABG bleeding severity grades 2-3: 23.5%, adjusted OR 4.43, 95%CI 2.15-9.15) compared to patients with normal preoperative platelet count. Mild preoperative thrombocytopenia is associated with increased risk of severe-massive bleeding, mortality, and other major adverse events after CABG. Such risks are markedly increased in patients with moderate-severe preoperative thrombocytopenia.
KW - Aged
KW - Coronary Artery Bypass/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Preoperative Period
KW - Prospective Studies
KW - Thrombocytopenia/etiology
U2 - 10.1080/09537104.2018.1466389
DO - 10.1080/09537104.2018.1466389
M3 - SCORING: Journal article
C2 - 29676943
VL - 30
SP - 480
EP - 486
JO - PLATELETS
JF - PLATELETS
SN - 0953-7104
IS - 4
ER -