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Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes

Authors

  • Bruce D. Spiess,

    Corresponding author
    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • David Royston,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • Jerrold H. Levy,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • Jane Fitch,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • Wulf Dietrich,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • Simon Body,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • John Murkin,

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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  • Andrea Nadel

    1. From the Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia; the Department of Anesthesia, Harefield Hospital, London, United Kingdom; the Department of Anesthesiology, Emory University, Atlanta, Georgia; the Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma; the Department of Anesthesiology, Munich Heart Institute, Munich, Germany; the Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; the Department of Anesthesia, University of Western Ontario, London, Ontario, Canada; and Global Statistics, Bayer Corporation, West Haven, Connecticut.
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Bruce D. Spiess, MD, Department of Anesthesiology, VCU, MCV Campus, PO Box 980695, Richmond, VA 23298-0695; e-mail: bdspiess@hsc.vcu.edu.

Abstract

BACKGROUND:  Platelet (PLT) transfusions are administered in cardiac surgery to prevent or treat bleeding, despite appreciation of the risks of blood component transfusion. The current analysis investigates the hypothesis that PLT transfusion is associated with adverse outcomes associated with coronary artery bypass graft surgery (CABG).

STUDY DESIGN AND METHODS:  Data originally collected during double-blind placebo-controlled phase III trials for licensure of Trasylol (aprotinin injection) were retrospectively analyzed. Adverse outcome data of patients (n = 1720) that received, and did not receive, perioperative PLT transfusion were compared. Logistic regression analysis was used to assess the association of perioperative adverse events with PLT transfusion. Propensity scoring analysis was used to verify results of the logistic regression.

RESULTS:  Patients receiving PLTs were more likely to have prolonged hospital stays, longer surgeries, more bleeding, re-operation for bleeding, and more RBC transfusions, and less likely to have full-dose aprotinin administration. Adverse events were statistically more frequent in patients that received one or more PLT transfusion. Logistic regression analysis showed that PLT transfusion was associated with infection, vasopressor use, respiratory medication use, stroke, and death. Propensity scoring analysis confirmed the risk of PLT transfusion.

CONCLUSIONS:  PLT transfusion in the perioperative period of CABG was associated with increased risk for serious adverse events. PLT transfusion may be a surrogate marker for sicker patients and have no causal role in the outcomes observed. However, a direct contribution to outcomes remains possible.

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