Efficacy of platelet transfusion in cardiac surgery

Abstract

Massive diffuse bleeding is still a problem in cardiovascular surgery. The first line treatment is platelet concentrate transfusion, although there is still insufficient information regarding efficacy, quantity, and timing. The objective of this prospective cohort study was to find out whether the amount of 4 apheresis platelet concentrates could reduce intraoperative bleeding and improve viscoelasticity and aggregometry. 10 patients were enrolled intraoperatively because of life-threatening diffuse bleeding after cardiopulmonary bypass and received 4 apheresis platelet concentrates back-to-back. The units were given every 5 minutes. After every unit, thromboelastometry, performed by ROTEM®, and aggregometry, performed by Multiplate®, were done together with Hematocrit, Hemoglobin, and Platelet Count. Hematocrit and Hemoglobin showed a statistically significant decrease of 14%, whereas Platelet Count showed a statistically significant increase of 205%. MCE-EXTEM increased statistically significant: 46%. There was no statistically significant increase in both ADP and COL results. Even a series of 4 platelet concentrates did not comprehensively improve both essential components of an adequate hemostasis: viscoelasticity and aggregation. Just the transfusion of platelet concentrates alone did not build a sufficient strategy improving hemostasis and reducing bleeding. A positive effect of surgical packing on stopping the bleeding could be seen.

Keywords:

• Cardiac surgery
• cardiopulmonary bypass
• hemorrhage
• platelet function
• platelet transfusion
• surgical packing

Details of authors’ contributions

LB, JM, and NRM contributed by data analysis and interpretation. All authors contributed by writing up the manuscript and by the approval of the version to be published. NRM collected the data and cared for the approval of the research Ethics Committee.

Acknowledgements

Not applicable.

Disclosure statement

The authors LB, JM and NRM report no potential conflict of interest.

Additional information

Funding

No external support was provided.