Postoperative Thrombocytopenia and Coagulopathy in Cardiac Surgery with Cardiopulmonary Bypass: Incidence and Outcomes after Non-Red Cell Blood Product Transfusion

Abstract

Background: Cardiopulmonary bypass (CPB) activates inflammatory and fibrinolytic pathways, potentially disrupting hemostasis. Transfusion of non-red cell blood product is a conventional method of restoring hemostasis and treating coagulopathy and thrombocytopenia, the two common adverse outcomes of CPB. Objective: To determine the incidence and outcomes of postoperative thrombocytopenia and coagulopathy in adult Thai cardiac surgery patients with CPB receiving non-red cell blood product transfusions. Materials and Methods: The present study included patients aged 18 years and older that underwent cardiac surgery with CPB at Siriraj Hospital between January 2017 and June 2018. Enrolled patients were divided into four groups, no non-red cell blood products in Group 1, platelets (PLT) only in Group 2, fresh frozen plasma (FFP) and/or cryoprecipitate (cryo) in Group 3, and PLT, FFP and/or cryo in Group 4. Patients, clinical status and histories, intraoperative outcomes, and perioperative outcomes were collected and assessed for all groups. Postoperative thrombocytopenia was defined by PLT counts less than 100,000 cells/mm3. Coagulopathy was defined by prothrombin time (PT) or activated partial thromboplastin time (aPTT) greater than 1.5 of its institutional reference values. Non-red cell blood product transfusions for cardiac patients were determined by their attending physician. Results: Of the 360 patients included, 61.7% were male, with a mean (±SD) age of 65.3±11.7 years, and BMI of 24.1±4.0 kg/m2. Most patients were classified as ASA-PS class 3 (71.9%), had elective surgeries (96.4%), history of antiplatelet use (65.8%), and coronary artery bypass graft (CABG) surgical procedure (56.9%). Postoperative thrombocytopenia was significantly more prevalent in Group 1 at 11.6%, followed by Group 3 at 9.5%, Group 4 at 3.7%, and Group 2 at 0% (p=0.010). Post-operative coagulopathy was more prevalent in Group 3 at 4.8%, followed by Group 2 at 4.1%, Group 1 at 3.9%, and Group 4 at 0.7%. Group 4 had a significantly greater incidence of anticoagulant use at 17.8% (p=0.007) and significantly longer CPB durations compared to the other groups at 146.6±74.7 minutes (p<0.01). Conclusion: The researchers’ study confirmed that preoperative antithrombotic use prior to cardiac surgical procedures and longer CPB duration influences physicians’ decision to transfuse. The present study recommended prohibiting prophylactic administration of FFP and PLT as well as implementing restrictive non-red cell blood product transfusion strategies.