PREOPERATIVE PLATELETPHERESIS DOES NOT REDUCE BLOOD-LOSS DURING CARDIAC-SURGERY

Citation
Sk. Boey et al., PREOPERATIVE PLATELETPHERESIS DOES NOT REDUCE BLOOD-LOSS DURING CARDIAC-SURGERY, Canadian journal of anaesthesia, 40(9), 1993, pp. 844-850
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
40
Issue
9
Year of publication
1993
Pages
844 - 850
Database
ISI
SICI code
0832-610X(1993)40:9<844:PPDNRB>2.0.ZU;2-H
Abstract
Acute preoperative plateletPheresis has been reported to be effective in reducing blood loss and blood component transfusion while improving haematological profiles in patients undergoing open-heart surgery. Ho wever, in these studies, the concomitant use of cell saver techniques may have been responsible for the beneficial effects because they remo ve free haemoglobin and activated procoagulants and, therefore, could mask the deleterious effects of combined plateletpheresis and cardiopu lmonary bypass (CPB). In the present study, 40 patients undergoing pri mary myocardial revascularization were randomly divided into two group s: a control group without plateletpheresis performed, and a second gr oup in which preoperative platelet-rich plasma 10 ml . kg-1 (PRP group ) was collected and later reinfused after reversal of heparin. Standar dized surgery, anaesthesia and CPB without concomitant cell saver tech niques were employed In the PRP group, blood transfusion was reduced ( 1.5 +/- 1.3 vs 2.4 +/- 1.3 units, P < 0.05) but this was accompanied b y lower postoperative haemoglobin concentrations. There were no differ ences in blood loss (992.6 +/- 3274 vs 8896 +/- 343.7 ml), fresh froze n plasma (2119 vs 3120 patients) or platelet requirements (1/19 vs 1/2 0 patients). Reinfusion of autologous PRP did not improve platelet cou nt and function, nor tests of coagulation. Fibrinogen concentrations w ere lower in the PRP group on the operative day (P < 0.05), suggesting increased fibrinogen consumption, and more patients in the PRP group had low haptoglobin levels during CPB (8/19 vs 0/20 patients, P < 0.00 5), which indicated greater haemolysis in this group. We conclude that acute preoperative plateletpheresis offers no advantage in haemostasi s during elective primary myocardial revascularization surgery.