Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Ann Thorac Surg. 2018 Aug;106(2):482-490. doi: 10.1016/j.athoracsur.2018.03.057. Epub 2018 Apr 26.
Essential thrombocythemia (ET) is a rare myeloproliferative disorder characterized by an unexplained thrombocytosis (>450 × 10/L) and associated vasomotor, thrombotic, and hemorrhagic manifestations. Although the literature detailing the perioperative management of patients with ET undergoing cardiac operations is sparse, major perioperative complications have been reported, particularly in poorly controlled patients presenting with platelet counts of 800 × 10/L or higher. The purpose of this study was to provide the experience at a large tertiary medical center in managing patients with ET undergoing cardiac operation and to summarize the available literature.
Patients with ET undergoing cardiac operations between January 1, 2006, and May 1, 2016, were identified. Perioperative data were exhaustively reviewed and recorded. An extensive literature search for "essential thrombocythemia" and "cardiac surgery" was performed.
During the study period, 25 patients with ET underwent cardiac operations, and 24 had immediate preoperative platelet counts of less than 800 × 10/L. Perioperative complications related to ET occurred in 1 of 25 patients (4%). The immediate preoperative platelet count was 181 × 10/L. A literature search identified 18 patients who underwent cardiac operations, with major perioperative complications occurring in 5 (28%), of which 4 of 5 had an immediate preoperative platelet count of 800 × 10/L or higher.
Patients with ET undergoing cardiac operations represent a complex cohort at risk for perioperative thrombotic or hemorrhagic complications, or both. Although not currently an indication for platelet reduction therapy by risk stratification criteria, preoperative cytoreduction to platelet counts of less than 800 × 10/L and perhaps lower should be considered in patients undergoing cardiac operations.
特发性血小板增多症（ET）是一种罕见的骨髓增生性疾病，其特征为不明原因的血小板增多症（>450×10/L），并伴有血管运动、血栓形成和出血表现。尽管文献中详细描述了接受心脏手术的 ET 患者的围手术期管理，但仍有报道称发生了主要围手术期并发症，尤其是在血小板计数>800×10/L 且控制不佳的患者中。本研究的目的是提供在大型三级医疗中心管理接受心脏手术的 ET 患者的经验，并总结现有文献。
确定了 2006 年 1 月 1 日至 2016 年 5 月 1 日期间接受心脏手术的 ET 患者。详细审查并记录围手术期数据。对“特发性血小板增多症”和“心脏手术”进行了广泛的文献检索。
研究期间，25 例 ET 患者接受了心脏手术，24 例患者术前血小板计数<800×10/L。与 ET 相关的围手术期并发症发生在 25 例患者中的 1 例（4%）。术前血小板计数为 181×10/L。文献检索确定了 18 例接受心脏手术的患者，其中 5 例（28%）发生了主要围手术期并发症，其中 4 例患者术前血小板计数为 800×10/L 或更高。
接受心脏手术的 ET 患者是一个复杂的高危群体，存在围手术期血栓形成或出血并发症，或两者兼而有之。尽管目前根据风险分层标准并非血小板减少治疗的指征，但对于接受心脏手术的患者，应考虑术前减少血小板计数至<800×10/L 甚至更低。
