Does a Platelet Transfusion Independently Affect Bleeding and Adverse Outcomes in Cardiac Surgery?

被引:29
作者
van Hout, Fabienne M. A. [1 ,4 ]
Hogervorst, Esther K. [1 ,7 ]
Rosseel, Peter M. J. [2 ]
van der Bom, Johanna G. [1 ,4 ]
Bentala, Mohamed [3 ]
van Dorp, Eveline L. A. [5 ]
van Geloven, Nan [6 ]
Brand, Anneke [1 ]
van der Meer, Nardo J. M. [2 ,8 ]
van de Watering, Leo M. G. [1 ]
机构
[1] Sanquin Leiden Univ Med Ctr, Ctr Clin Transfus Res, Leiden, Netherlands
[2] Amphia Hosp, Dept Cardiac Anesthesiol & CU, Breda, Netherlands
[3] Amphia Hosp, Dept Cardiothorac Surg, Breda, Netherlands
[4] Leiden Univ Med Ctr, Dept Clin Epidemiol, Leiden, Netherlands
[5] Leiden Univ Med Ctr, Dept Anesthesiol, Leiden, Netherlands
[6] Leiden Univ Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
[7] Univ Groningen, Univ Med Ctr Groningen, Dept Anesthesia, Groningen, Netherlands
[8] TIAS Tilburg Univ, Tilburg, Netherlands
关键词
BLOOD-TRANSFUSION; ANTIPLATELET THERAPY; RE-EXPLORATION; RISK; COMPLICATIONS; MORTALITY; ASSOCIATION; MORBIDITY; PLASMA; STROKE;
D O I
10.1097/ALN.0000000000001518
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients. Methods: For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1: 3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified. Results: The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However, patients in the intervention group experienced less blood loss and required vasoactive medication 139 of 169 (82%) versus 370 of 507 (74%; odds ratio, 1.65; 95% CI, 1.05 to 2.58), prolonged mechanical ventilation 92 of 169 (54%) versus 226 of 507 (45%; odds ratio, 1.47; 94% CI, 1.03 to 2.11), prolonged intensive care 95 of 169 (56%) versus 240 of 507 (46%; odds ratio, 1.49; 95% CI, 1.04 to 2.12), erythrocytes 75 of 169 (44%) versus 145 of 507 (34%; odds ratio, 1.55; 95% CI, 1.08 to 2.23), plasma 29 of 169 (17%) versus 23 of 507 (7.3%; odds ratio, 2.63; 95% CI, 1.50-4.63), and platelets 72 of 169 (43%) versus 25 of 507 (4.3%; odds ratio, 16.4; 95% CI, 9.3-28.9) more often compared to the reference group. Conclusions: In this retrospective analysis, cardiac surgery patients receiving platelet transfusion in the operating room experienced less blood loss and more often required vasoactive medication, prolonged ventilation, prolonged intensive care, and blood products postoperatively. However, early platelet transfusion was not associated with reinterventions, thromboembolic complications, infections, organ failure, or mortality.
引用
收藏
页码:441 / 449
页数:9
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