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Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis.
Ann Thorac Surg. 2020 Jun 22 [Online ahead of print]AT

Abstract

BACKGROUND

Blood transfusion is a well-established independent risk factor for mortality in patients undergoing cardiac surgery but the impact of platelet transfusion is less clear. We performed a systematic review and meta-analysis of observational studies comparing outcomes of patients who received platelet transfusion following cardiac surgery.

METHODS

We searched MEDLINE and EMBASE databases to January 2019 for studies comparing peri-operative outcomes in patients undergoing cardiac surgery with and without platelet transfusion.

RESULTS

There were 9 observational studies reporting on 101,511 patients: 12% with and 88% without platelet transfusion. In unmatched/unadjusted studies, patients who received platelet transfusion were older with greater incidence of renal, peripheral and cerebrovascular disease, myocardial infarction, left ventricular dysfunction, and anemia. They were more likely to have non-elective, combined surgery; pre-operative hemodynamic instability and endocarditis; and more likely to be on clopidogrel preoperatively. Perioperative complications were significantly increased without adjusting for these baseline differences. After pooling only matched/adjusted data, differences were not found in patients who did vs did not receive platelets for operative mortality (risk ratio [RR] 1.26, 95%CI:0.69-2.32, p=0.46, 5 studies), stroke (RR 0.94, 95%CI:0.62-1.45, p=0.79, 5 studies), myocardial infarction (RR1.29, 95%CI:0.95-1.77, p=0.11, 3 studies), reoperation for bleeding (RR1.20, 95%CI:0.46-3.18, p=0.71, 3 studies), infection (RR1.02, 95%CI:0.86-1.20, p=0.85, 6 studies), and peri-operative dialysis (RR0.91, 95%CI:0.63-1.32, p=0.62, 3 studies).

CONCLUSIONS

After accounting for baseline differences, platelet transfusion was not linked with perioperative complications in cardiac surgery patients. Given the small number of observational studies, these findings should be considered hypothesis generating.

Authors+Show Affiliations

Divisions of Cardiac Surgery. Electronic address: yanagawab@smh.ca.Divisions of Cardiac Surgery.Divisions of Cardiac Surgery.Departments of Anesthesia; Critical Care and Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.Department of Anesthesia & Perioperative Medicine, MEDICI Centre, University of Western Ontario.Department of Anesthesia & Perioperative Medicine, MEDICI Centre, University of Western Ontario.Divisions of Cardiac Surgery.Critical Care and Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32585201

Citation

Yanagawa, Bobby, et al. "Platelet Transfusion in Cardiac Surgery: a Systematic Review and Meta-Analysis." The Annals of Thoracic Surgery, 2020.
Yanagawa B, Ribeiro R, Lee J, et al. Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2020.
Yanagawa, B., Ribeiro, R., Lee, J., Mazer, C. D., Cheng, D., Martin, J., Verma, S., & Friedrich, J. O. (2020). Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2020.04.139
Yanagawa B, et al. Platelet Transfusion in Cardiac Surgery: a Systematic Review and Meta-Analysis. Ann Thorac Surg. 2020 Jun 22; PubMed PMID: 32585201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis. AU - Yanagawa,Bobby, AU - Ribeiro,Roberto, AU - Lee,Jessica, AU - Mazer,C David, AU - Cheng,Davy, AU - Martin,Janet, AU - Verma,Subodh, AU - Friedrich,Jan O, AU - ,, Y1 - 2020/06/22/ PY - 2019/10/12/received PY - 2020/03/26/revised PY - 2020/04/24/accepted PY - 2020/6/26/entrez PY - 2020/6/26/pubmed PY - 2020/6/26/medline KW - cardiac surgery KW - platelet transfusion JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. N2 - BACKGROUND: Blood transfusion is a well-established independent risk factor for mortality in patients undergoing cardiac surgery but the impact of platelet transfusion is less clear. We performed a systematic review and meta-analysis of observational studies comparing outcomes of patients who received platelet transfusion following cardiac surgery. METHODS: We searched MEDLINE and EMBASE databases to January 2019 for studies comparing peri-operative outcomes in patients undergoing cardiac surgery with and without platelet transfusion. RESULTS: There were 9 observational studies reporting on 101,511 patients: 12% with and 88% without platelet transfusion. In unmatched/unadjusted studies, patients who received platelet transfusion were older with greater incidence of renal, peripheral and cerebrovascular disease, myocardial infarction, left ventricular dysfunction, and anemia. They were more likely to have non-elective, combined surgery; pre-operative hemodynamic instability and endocarditis; and more likely to be on clopidogrel preoperatively. Perioperative complications were significantly increased without adjusting for these baseline differences. After pooling only matched/adjusted data, differences were not found in patients who did vs did not receive platelets for operative mortality (risk ratio [RR] 1.26, 95%CI:0.69-2.32, p=0.46, 5 studies), stroke (RR 0.94, 95%CI:0.62-1.45, p=0.79, 5 studies), myocardial infarction (RR1.29, 95%CI:0.95-1.77, p=0.11, 3 studies), reoperation for bleeding (RR1.20, 95%CI:0.46-3.18, p=0.71, 3 studies), infection (RR1.02, 95%CI:0.86-1.20, p=0.85, 6 studies), and peri-operative dialysis (RR0.91, 95%CI:0.63-1.32, p=0.62, 3 studies). CONCLUSIONS: After accounting for baseline differences, platelet transfusion was not linked with perioperative complications in cardiac surgery patients. Given the small number of observational studies, these findings should be considered hypothesis generating. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/32585201/Platelet_Transfusion_in_Cardiac_Surgery:_A_Systematic_Review_and_Meta-Analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(20)30960-7 DB - PRIME DP - Unbound Medicine ER -
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