Keles Ercan, Bilen Cagatay, Aygun Hakan, Gencpinar Tugra, Catalyurek Hudai
Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey.
Health Sciences University Dr Behcet Uz Training and Research Hospital, Izmir, Turkey.
Perfusion. 2023 May;38(4):781-790. doi: 10.1177/02676591221082496. Epub 2022 Apr 4.
Thrombocytopenia (platelet count below 150 x 10/μL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non-heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors.
In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 10/μL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis.
A total of 501 patients were diagnosed as having non-heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 10 vs.117 x 10/μL; < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757-46.363]; = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867-5.114]; < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638-14.889]; = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923-64.023]; = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046-1.420]; = 0.011).
Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.
血小板减少症（血小板计数低于150×10⁹/μL）是心脏直视手术后常见的情况，可导致各种并发症，包括患者死亡。本研究旨在确定心脏直视手术中非肝素诱导的血小板减少症的程度，并突出相关因素。
在这项队列研究中，对5年内接受瓣膜和/或冠状动脉搭桥手术的842例患者进行了回顾性分析。心脏直视手术后，术后12小时和24小时全血细胞计数中血小板计数低于150×10⁹/μL的患者被归类为血小板减少症患者。320例无血小板减少症的患者和21例肝素诱导的血小板减少症可能性高的患者被排除在研究之外。采用逻辑回归分析评估中度至重度血小板减少症中自变量的相关性：分析纳入年龄组、性别、基础疾病、症状、手术类型、体外循环时间、搏动或非搏动持续时间、体温过低程度、血液稀释、氧合器类型、主动脉内球囊的使用以及红细胞输注次数。
共有501例患者被诊断为非肝素诱导的血小板减少症，其中64.3%为男性。377例（75.2%）患者为轻度血小板减少症，124例（24.7%）患者为中度至重度血小板减少症。术后血小板计数显著低于术前血小板计数（213×10⁹ vs.117×10⁹/μL；P<0.001）。与单纯冠状动脉搭桥相比，中度至重度血小板减少症与年龄≥80岁（比值比[OR]=9.026，95%置信区间[CI]：[1.757 - 46.363]；P = 0.008）、单纯瓣膜手术（OR = 3.090，95%CI：[1.867 - 5.114]；P<0.001）以及瓣膜手术联合冠状动脉搭桥（OR = 4.938，95%CI：[1.638 - 14.889]；P = 0.005）、氧合器类型（尼普洛活力型与亲和型相比，OR = 11.097，95%CI：[1.923 - 64.023]；P = 0.007）、红细胞输注次数（OR = 1.219，95%CI：[1.046 - 1.420]；P = 0.011）相关。
80岁及以上年龄、包括心脏瓣膜手术在内的手术程序以及红细胞输注次数与中度至重度血小板减少症的风险相关。本研究为心脏直视手术后可能导致中度至重度血小板减少症的危险因素提供了指导。然而，未来的多中心前瞻性随机研究可能会提供关于该主题更详细的信息。
