Risk Factors of Thrombocytopenia After Cardiac Surgery with Cardiopulmonary Bypass

Abstract

Introduction Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10 th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results The 10 th quantile of all enrolled patients (75×10 9 /L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P =0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P =0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P <0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P <0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P =0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P <0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P <0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P <0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Risk factors and prediction model for thrombocytopenia following coronary artery bypass graft surgery in elderly Chinese population

“…These factors may include patient-related variables, such as age, preoperative PLT count, comorbidities (e.g., chronic kidney disease, diabetes mellitus), and medications (e.g., antiplatelet agents) ( 11 ). Surgical factors, such as the duration of CPB, aortic cross-clamp time, and complexity of the procedure can also influence PLT function and count ( 7 ).…”

“…In a retrospective study conducted by Yan et al ( 7 ), the objective was to investigate the risk factors associated with thrombocytopenia after cardiac surgery with CPB. The analysis indicated that the following are positive predictors of thrombocytopenia: valve surgery included age >60 years, small body surface area, preoperative thrombocytopenia, and CPB time.…”

“…In this study, the incidence of thrombocytopenia after CABG was approximately 22.8%. Yan et al reported an incidence of 10.2% ( 7 ) and Keles et al reported 14.7% ( 8 ). These discrepancies may be attributed to differences in patient populations and thrombocytopenia definitions.…”

“…Advanced age has been identified as a significant risk factor for thrombocytopenia, with older patients being more susceptible to thrombocytopenia following surgery. Several studies have demonstrated that older age is independently associated with lower PLT levels ( 7 , 8 ). In elderly patients (age ≥65 years), the incidence of thrombocytopenia is higher than that in younger patients due to age-related changes, including physiological, structural, and functional alterations ( 9 ).…”