Abstract 300: Determinants and Impact of Platelet Transfusions After Cardiac Surgery
Objectives: Patients undergoing cardiac surgery may receive blood products during the perioperative period. While increasing attention has been drawn to red blood cell transfusions given its associated cost and morbidity, less work has been devoted to other frequently delivered blood component therapies, including platelets. We sought to identify pre-operative determinants and outcomes of platelet transfusion in the setting of coronary artery bypass grafting (CABG) surgery.
Methods: Data from 4,574 patients undergoing on pump, isolated, non-emergent CABG surgery between July 2011 and June 2012 were entered into a statewide collaborative database. Logistic regression models were constructed to assess determinants and impact of platelet transfusions, and calculate crude and risk-adjusted odds ratios (OR). Post-operative outcomes included in-hospital mortality, re-operation for bleeding and prolonged (>24 hours) ventilation.
Results: Platelet transfusions occurred among 14.7% (674 of 4574) of CABG procedures. Platelet transfusions were associated with increased odds of death (ORadj 4.2), reoperation for bleeding (ORadj 23.3), and prolonged ventilation (ORadj 3.4), all p<0.001. As expected, those receiving platelets had higher odds of having received packed red blood cells (OR 7.9, p<0.001). We found 10 variables significantly associated with platelet transfusions, including: adenosine diphosphate (ADP) receptor inhibitors or antiplatelet medications, ejection fraction, albumin, creatinine, platelet count, intra-aortic balloon pump use, prior cardiovascular operation, body surface area, and age. Adjusted ORs (with 95% confidence intervals) are displayed in the Figure.
Conclusions: Platelet use was associated with increased odds of morbidity and mortality after CABG surgery. We identified 10 pre-operative factors associated with platelet transfusions. This study enhances our understanding of risk factors for traditionally overlooked yet potentially harmful blood components. Given these findings, future work should focus on identifying practices that may assist in reducing rates of platelet transfusions.
Author Disclosures: P. Al-Attar: None. S.F. Bolling: None. G. Paone: None. A. DeLucia: None. P.F. Theurer: None. R.L. Prager: None. D.S. Likosky: None.
- © 2014 by American Heart Association, Inc.