University of Leeds, Faculty of Health and Medicine, Leeds, UK.
St George's Hospital Medical School, University of London, London, UK.
Heart Lung Circ. 2022 Mar;31(3):304-312. doi: 10.1016/j.hlc.2021.10.012. Epub 2021 Nov 15.
Polycythaemia vera (PV) is a condition that may potentially put patients undergoing cardiac surgery at an increased risk of bleeding and thrombosis; however, there is currently a paucity of literature regarding the management of these patients. We aim to examine the literature in this systematic review to indicate the interventions that may be considered to minimise complications.
We conducted a literature search using keywords and MeSH terms to identify articles discussing PV and cardiac surgery. The studies were identified and qualitatively analysed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol.
In total, 10 case reports representing 11 patients were identified for this systematic review and were included in qualitative analysis. 63.6% of patients had preoperative intermittent phlebotomy, and the majority of patients received postoperative therapy that involved one antiplatelet agent and one anticoagulant. Generous perioperative fluid management, phlebotomy, preservation of core body temperature, early extubation, monitoring of myocardial ischaemia, infarction and vascular events, intense chest physiotherapy and patient mobilisation are important to consider to reduce the risk of complications arising from surgery.
These considerations should be systematically discussed in a multidisciplinary team, where the acute surgical need can be balanced appropriately against the risk of haemorrhage and thrombosis.
真性红细胞增多症（PV）可能使接受心脏手术的患者出血和血栓形成的风险增加；然而，目前关于这些患者的管理的文献很少。我们旨在通过系统评价审查文献，以确定可能有助于减少并发症的干预措施。
我们使用关键词和 MeSH 术语进行文献检索，以确定讨论 PV 和心脏手术的文章。使用系统评价和荟萃分析的首选报告项目（PRISMA）协议对研究进行识别和定性分析。
总共确定了 10 篇病例报告，代表 11 名患者，对这些病例进行了系统评价和定性分析。63.6%的患者术前间歇性放血，大多数患者术后接受的治疗包括一种抗血小板药物和一种抗凝药物。充分的围手术期液体管理、放血、保持核心体温、早期拔管、监测心肌缺血、梗死和血管事件、强化胸部物理治疗和患者活动对于降低手术相关并发症的风险非常重要。
这些考虑因素应在多学科团队中进行系统讨论，在该团队中，可以适当地平衡急性手术需求与出血和血栓形成的风险。
