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Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis
Bobby Yanagawa1, Roberto Ribeiro1, Jessica Lee1
1Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Insights
Platelet transfusions after cardiac surgery do not appear to increase complications like mortality or stroke when patient baseline differences are considered. Further research is needed due to the limited number of studies.
Area of Science:
- Cardiology
- Transfusion Medicine
- Surgical Outcomes
Background:
- Blood transfusion is a known risk factor for mortality in cardiac surgery patients.
- The specific impact of platelet transfusion on outcomes after cardiac surgery is less understood.
- Observational studies are needed to clarify the association between platelet transfusion and perioperative complications.
Purpose of the Study:
- To systematically review and meta-analyze observational studies to determine the impact of platelet transfusion on perioperative outcomes in cardiac surgery patients.
- To compare outcomes between patients who received platelet transfusions and those who did not, after adjusting for baseline characteristics.
Main Methods:
- Systematic review and meta-analysis of nine observational studies.
- Inclusion of data from 101,511 patients undergoing cardiac surgery.
- Searched MEDLINE and EMBASE databases up to January 2019.
Main Results:
- Unadjusted analyses showed patients receiving platelets had more comorbidities and complex surgical profiles.
- After matching or adjusting for baseline differences, no significant differences were found in operative mortality, stroke, myocardial infarction, reoperation for bleeding, infection, or need for perioperative dialysis.
- Pooled data from matched/adjusted studies indicated no increased risk associated with platelet transfusion.
Conclusions:
- Platelet transfusion is not associated with increased perioperative complications in cardiac surgery patients when baseline differences are accounted for.
- The findings suggest that confounding factors in unadjusted analyses may have previously suggested a link.
- These results are considered hypothesis-generating due to the limited number of observational studies available.
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 after cardiac surgery.
Methods:
We searched MEDLINE and EMBASE databases to January 2019 for studies comparing perioperative outcomes in patients undergoing cardiac surgery with and without platelet transfusion.
Results:
There were nine observational studies reporting 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 nonelective, combined surgery; preoperative hemodynamic instability and endocarditis; and more likely to be receiving clopidogrel preoperatively. Perioperative complications were significantly increased without adjusting for these baseline differences. After pooling only matched/adjusted data, differences were not found between patients who did receive platelets and patients who did not in operative mortality (risk ratio [RR] 1.26; 95% confidence interval [CI], 0.69 to 2.32, P = .46, five studies), stroke (RR 0.94; 95% CI, 0.62 to 1.45; P = .79; five studies), myocardial infarction (RR 1.29; 95% CI, 0.95 to 1.77; P = .11; three studies), reoperation for bleeding (RR 1.20; 95% CI, 0.46 to 3.18; P = .71; three studies), infection (RR 1.02; 95% CI, 0.86 to 1.20; P = .85; six studies); and perioperative dialysis (RR 0.91; 95% CI, 0.63 to 1.32; P = .62; three 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.
