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. However, in these studies, the concomitant use of cell saver techniques may have been responsible for the beneficial effects because they remove free haemoglobin and activated procoagulants and, therefore, could mask the deleterious effects of combined plateletpheresis and cardiopulmonary bypass (CPE). In the present study, 40 patients undergoing primary myocardial revascularization were randomly divided into two groups: a control group without plateletpheresis performed, and a second group in which preoperative platelet-rich plasma 10 ml · kg−1 (PRP group) was collected and later reinfused after reversal of heparin. Standardized surgery, anaesthesia and CPB without concomitant cell saver techniques 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 by lower postoperative haemoglobin concentrations. There were no differences in blood loss (992.6 ± 327.4 vs 889.6 ± 343.7 ml), fresh frozen plasma (2/19 vs 3/20 patients) or platelet requirements (1/19 vs 1 /20 patients). Reinfusion of autologous PRP did not improve platelet count and function, nor tests of coagulation. Fibrinogen concentrations were 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 < 0.005), which indicated greater haemolysis in this group. We conclude that acute preoperative plateletpheresis offers no advantage in haemostasis during elective primary myocardial revascularization surgery.
Résumé
La thrombocytaphérèse aiguë préopératoire a été réputée pour réduire les pertes sanguines et al transfusion de composés sanguins tout en améliorant le profit hématologique des patients opérés a coeur ouvert. Cependant, dans les études à ce sujet, l’utilisation simultanée de techniques de « cell saver » peut avoir été responsable des effets bénéfiques parce que ces techniques enlèvent l’hémoglobine libre et les procoagulants activés et peuvent ainsi masquer les effets néfastes dus à la combinaison de la thrombocytaphérèse et de la circulation extracorporelle (CEC). Dand l’étude actuelle, 40 patients subissant une premiere revascularisation myocardique ont été aléatoirement répartis en deux groupes: un groupe contrôle sans réalisation de thrombocytaphérèse et un second groupe dans lequel on a prélevé en préoperatoire 10 ml · kg−1 de plasma riche en plaquettes (groupe PRP) retransfusé plus tard après la neutralisation de l’héparine. La chirurgie, l’anesthésie et la CEC ont été standardisées et il n’y a pas eu de techniques simultanées de cell saver. Dans le groupe PRP, les transfusions sanguines ont été réduites (1,5 ± 1,3 versus 2,4 ± 1,3 unité, P < 0,05) mais les concentrations d’hémoglobine post-opératoire ont été plus basses. Il n’y a pas eu de difference en perte sanguine (992,6 ± 327,4 versus 889,6 ± 343,7 ml), et en besoin de plasma frais congelé (2/19 versus 3/20 patients) ou de plaquettes (1/ 19 versus 1/20 patients). La retransfusion de PRP autologue n’a pas amélioré le nombre et la fonction plaquettaire, ni les tests de coagulation. Les concentrations de fibrinogène ont été inférieures dans le groupe PRP le jour de l’intervention (P < 0.05) suggérant une augmentation de la consommation de fibrinogène et plus de patients dans le groupe PRP ont eu des niveaux bas d’haptoglobine pendant la CEC (8/19 versus 0/ 20 patients, P< 0,005) ce qui indique une plus grande hémolyse dans ce groupe. Nous concluons que la thrombocytaphérèse aiguë préopératoire n’offre pas d’avantage pour l’hémostase pendant une chirurgie programmée de première revascularisation myocardique.
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This study was supported in part by Haemonetics Corporation, USA.
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Boey, S.K., Ong, B.C. & Dhara, S.S. Preoperative plateletpheresis does not reduce blood loss during cardiac surgery. Can J Anaesth 40, 844–850 (1993). https://doi.org/10.1007/BF03009256
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DOI: https://doi.org/10.1007/BF03009256