McGrath Tory, Koch Colleen Gorman, Xu Meng, Li Liang, Mihaljevic Tomislav, Figueroa Priscilla, Blackstone Eugene H
Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, Ohio, USA.
Ann Thorac Surg. 2008 Aug;86(2):543-53. doi: 10.1016/j.athoracsur.2008.04.051.
Platelet transfusion has been reported to confer increased morbidity after cardiac surgery but prior studies were limited by confounding variables including red blood cell (RBC) transfusions. Our objective was to examine the impact of platelet transfusion on outcomes in cardiac surgery controlling perioperative risk factors.
A total of 32,298 patients underwent on-pump isolated coronary artery bypass grafting (CABG), an isolated valve, or a combined CABG and valve procedure between January 1, 1993 and January 1, 2006. Regression analysis and propensity methodology was employed to assess the association between platelet transfusion and morbidity.
Univariate comparisons demonstrated that patients who received platelet transfusions had increased morbidity. After risk adjustment with both multivariable regression and propensity methods, platelet transfusion was not significantly associated with in-hospital mortality: odds ratio (OR) 0.74 confidence limits 0.58, 0.95, p = 0.017 and 2.05% vs 3.06%, p = 0.017, respectively. Among 2,774 propensity matched-pairs, platelet transfusion was associated with similar or reduced morbidity, platelets versus no platelets: cardiac 2.42% vs 1.77%, p = 0.09; pulmonary 8.94% vs 9.88%, p = 0.23; renal 1.33% vs 1.48%, p = 0.65; neurologic 2.27% vs 3.21%, p = 0.033; serious infection 4.15% vs 5.34%, p = 0.037; and composite outcome 15.0% vs 17.2%, p = 0.024. Among a propensity-matched subgroup of patients never administered a concomitant RBC transfusion, platelet transfusion was not associated with increased morbidity: 4.49% vs 2.99%, p = 0.31.
Platelet transfusion was not found to increase morbid risk after cardiac surgery. Our results should not be interpreted as advocating platelet transfusions in cardiac surgery; rather, platelet transfusion empirically in the setting of persistent microvascular bleeding is not associated with increased morbid risk.
据报道，心脏手术后输注血小板会增加发病率，但先前的研究受到包括红细胞（RBC）输血在内的混杂变量的限制。我们的目的是在控制围手术期危险因素的情况下，研究血小板输注对心脏手术结局的影响。
1993年1月1日至2006年1月1日期间，共有32298例患者接受了体外循环下单纯冠状动脉旁路移植术（CABG）、单纯瓣膜手术或CABG与瓣膜联合手术。采用回归分析和倾向评分方法评估血小板输注与发病率之间的关联。
单因素比较显示，接受血小板输注的患者发病率增加。在采用多变量回归和倾向评分方法进行风险调整后，血小板输注与住院死亡率无显著相关性：比值比（OR）为0.74，置信区间为0.58、0.95，p = 0.017，分别为2.05%和3.06%，p = 0.017。在2774对倾向评分匹配的患者中，血小板输注与发病率相似或降低相关，血小板组与无血小板组相比：心脏相关发病率为2.42%对1.77%，p = 0.09；肺部相关发病率为8.94%对9.88%，p = 0.23；肾脏相关发病率为1.33%对1.48%，p = 0.65；神经系统相关发病率为2.27%对3.21%，p = 0.033；严重感染率为4.15%对5.34%，p = 0.037；综合结局为15.0%对17.2%，p = 0.024。在从未同时输注RBC的倾向评分匹配亚组患者中，血小板输注与发病率增加无关：4.49%对2.99%，p = 0.31。
未发现血小板输注会增加心脏手术后的发病风险。我们的结果不应被解释为提倡在心脏手术中输注血小板；相反，在持续性微血管出血情况下经验性输注血小板与发病风险增加无关。
