Platelet Transfusion After Cardiac Surgery

Fletcher, Calvin; Hinton, Jake V; Xing, Zhongyue; Perry, Luke A; Karamesinis, Alexandra; Shi, Jenny; Penny-Dimri, Jahan C.; Ramson, Dhruvesh M.; Liu, Zhengyang; Smith, Julian A.; Segal, Reny; Coulson, Tim G; Bellomo, Rinaldo

doi:10.1053/j.jvca.2022.12.009

Cited by 10 publications

(7 citation statements)

References 43 publications

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“…We did not observe a significant difference in composite infection rates between the FFP and PLTS group. This finding contradicts several previous studies which report reduced infection rates with PLTS and increased infection rates with FFP [ 29 , 30 ].…”

Section: Discussioncontrasting

confidence: 99%

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Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients

Hinton,

Fletcher,

Perry

et al. 2024

PLoS ONE

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Background Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown. Methods We conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005–2021 across 58 sites were included. The primary outcome was operative mortality. Results Of 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; P<0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P<0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P<0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001). Conclusion In perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting.

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Section: Discussioncontrasting

confidence: 99%

“…However, a large portion of available evidence is based on studies which are underpowered, do not control for the amount of blood product given, and do not account for the effects of confounding by indication. Finally, recent evidence suggests that the use of PLTS in cardiac surgery patients may be safe [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients

Hinton,

Fletcher,

Perry

et al. 2024

PLoS ONE

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“…This means that temporal associations between platelet transfusion, other blood product transfusions, and short-term outcomes cannot be accurately established, and some outcomes may have preceded platelet transfusion. However, as noted in our previous analysis in an American ICU setting, it is clear that most platelet transfusions in the immediate postoperative period occur early in the first 24 hours of ICU admission, 39 and comparable results would be expected in an Australian context. Thus, the significant majority of outcomes, including infection and mortality, would occur after platelet transfusion.…”

Section: Discussionsupporting

confidence: 81%

Platelet Transfusion in Cardiac Surgery: An Entropy-Balanced, Weighted, Multicenter Analysis

Fletcher

Hinton

Xing

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Platelet transfusion is common in cardiac surgery, but some studies have suggested an association with harm. Accordingly, we investigated the association of perioperative platelet transfusion with morbidity and mortality. METHODS: We conducted a retrospective analysis of prospectively collected data from the Australian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. We included consecutive adults from 2005 to 2018 across 40 centers. We used inverse probability of treatment weighting via entropy balancing to investigate the association of perioperative platelet transfusion with our 2 primary outcomes, operative mortality (composite of both 30-day and in-hospital mortality) and 90-day mortality, as well as multiple other clinically relevant secondary outcomes. RESULTS: Among 119,132 eligible patients, 25,373 received perioperative platelets and 93,759 were considered controls. After entropy balancing, platelet transfusion was associated with reduced operative mortality (odds ratio [OR], 0.63; 99% confidence interval [CI], 0.47–0.84; P < .0001) and 90-day mortality (OR, 0.66; 99% CI, 0.51–0.85; P < .0001). Moreover, it was associated with reduced odds of deep sternal wound infection (OR, 0.57; 99% CI, 0.36–0.89; P = .0012), acute kidney injury (OR, 0.84; 99% CI, 0.71–0.99; P = .0055), and postoperative renal replacement therapy (OR, 0.71; 99% CI, 0.54–0.93; P = .0013). These positive associations were observed despite an association with increased odds of return to theatre for bleeding (OR, 1.55; 99% CI, 1.16–2.09; P < .0001), pneumonia (OR, 1.26; 99% CI, 1.11–1.44; P < .0001), intubation for longer than 24 hours postoperatively (OR, 1.13; 99% CI, 1.03–1.24; P = .0012), inotrope use for >4 hours postoperatively (OR, 1.14; 99% CI, 1.11–1.17; P < .0001), readmission to hospital within 30 days of surgery (OR, 1.22; 99% CI, 1.11–1.34; P < .0001), as well as increased drain tube output (adjusted mean difference, 89.2 mL; 99% CI, 77.0 mL–101.4 mL; P < .0001). CONCLUSIONS: In cardiac surgery patients, perioperative platelet transfusion was associated with reduced operative and 90-day mortality. Until randomized controlled trials either confirm or refute these findings, platelet transfusion should not be deliberately avoided when considering odds of death.

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“…Other researchers examined over 12,000 cardiac surgeries and found no association between platelet transfusion and mortality (OR 1.28, 99% CI: 0.49-3.35) [12,13]. When matching 195 patients who received cryoprecipitate at a median time of 1.7 hours after arrival in the intensive care unit with 743 controls, there was no increased mortality (OR 1.1; 99%.…”

Section: Discussionmentioning

confidence: 99%

“…CI 0.43-2.84) or kidney injury (OR 1.03). Decreased infections appeared in those who received platelets, which may be secondary to earlier administration synergistic with other blood components [6,12]. European practice guidelines list TEG as Class IIa, as helpful to "consider."…”

Section: Discussionmentioning

confidence: 99%

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

Skidmore,

Borne,

Kallurkar

et al. 2023

Preprint

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Introduction: In recent years, platelets have been in short supply and high demand. Approximately one in five cardiac surgery patients require platelets. In our safety-net hospital, however, the incidence is over 40%. Renal dysfunction, long cardiopulmonary bypass (CPB) times, and absence of tranexamic acid (TXA) are common risk factors for requiring platelet transfusions. Methods: Our hypothesis was fewer platelets would be transfused within two hours after bypass under these three conditions: creatinine is low, predicted surgery duration is short, and TXA is uniformly administered. Our anesthesia department designed this retrospective before-and-after observational study when the surgery department decided to narrow preoperative criteria respective to these three elements. The Institutional Review Board of Louisiana State University Health Sciences Center Shreveport approved of the protocol and waived individual informed consent. We compared timing of platelet transfusions (within 7 days) in consecutive patients who had CPB during the first ninety days of 2022 to those in 2023 using t-tests in SAS 9.3. Confounders included age, weight, anticoagulants, gender, and the platelet counts and hemoglobin immediately prior to platelet transfusion. Secondary outcomes were postoperative day two creatinine and other components transfused. Results: Preoperatively creatinine tended to be higher in 2022 at 1.5 vs 1.1, reaching significance postoperatively at 1.9 vs 1.1 (p=0.02). Bypass times decreased from 174 to 124 minutes (p=0.06). TXA use increased from 18 of 28 to 26 of 29 patients. Platelet counts increased on bypass from 142 to 173 (p=0.06). Platelet and hemoglobin nadirs were higher (day 3: 8g/dL vs 8.8, p=0.04; 98 vs 138, p=0.005). Platelet units transfused per patient tended to increase (0.75+/-1 vs 0.93+/-1.5); if exposed, patients tended to receive more units (2.1+/-1.3 vs 2.5+/-1.4) sooner. Changes in transfusions for red cells were nonsignificant at 1.97 per patient to 1.21, cryoprecipitate 0.36 to 0.69, and FFP 0.93 to 0.83. Conclusions: This is the first study examining timing of platelet transfusions after bypass. In the present investigation, we measured platelet count during bypass and prothrombin hours after arrival in the intensive care. Platelets were often administered in sets of two because of scarce immediate supply, partly from lack of an agitator table. More importantly, these data support a need for point-of-care thromboelastograms intraoperatively, but the cost has been prohibitive. Some centers’ algorithms list triggers for transfusion by fibrinogen and prothrombin times, available immediately after separation from bypass.

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Platelet Transfusion After Cardiac Surgery

Cited by 10 publications

References 43 publications

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients

Platelet Transfusion in Cardiac Surgery: An Entropy-Balanced, Weighted, Multicenter Analysis

The Significant Role of Point-Of Care Coagulation Studies: Shorter Cardiac Surgery, Better Renal Function and Tranexamic Acid Can Not Alone Reduce Early Platelet Transfusions

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