Perioperative thrombocytopenia

Abstract

Purpose of reviewIn this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia. Recent findingsLarge contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic platelet transfusion is limited and refractoriness to platelet transfusion is common. A number of options exist to optimize platelet counts prior to procedures, which include steroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and monoclonal antibodies. In addition, intraoperative alternatives and adjuncts to transfusion should be considered. It appears reasonable to use prophylactic desmopressin and antifibrinolytic agents, whereas activated recombinant factor VII could be considered in severe bleeding. Other options include enhancing thrombin generation with prothrombin complex concentrate or increasing fibrinogen levels with fibrinogen concentrate or cryoprecipitate.

Editorial: Perioperative medicine: a bridge (not) too far!

“…While not as prevalent as anemia, preoperative thrombocytopenia is also associated with increased odds of transfusion and perioperative mortality, with risk increasing progressively at decreasing platelet counts. Lombard et al [14] present practical points in assessing and managing perioperative thrombocytopenia, detailing emerging therapies available for temporary rise in platelet counts prior to invasive procedures (such as thrombopoietin receptor agonists for patients with immune thrombocytopenia or chronic liver disease).…”