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Perioperative thrombocytopenia.

Frederick W Lombard1, Wanda M Popescu2, Adriana D Oprea2

  • 1Vanderbilt University Medical Center, Department of Anesthesiology, Nashville, Tennessee.

Current Opinion in Anaesthesiology
|May 3, 2021
PubMed
Summary
This summary is machine-generated.

Perioperative thrombocytopenia affects 8% of patients and increases bleeding risk. A multimodal strategy, not just platelet counts, can effectively decrease bleeding risks.

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Area of Science:

  • Hematology
  • Anesthesiology
  • Surgical Oncology

Background:

  • Preoperative thrombocytopenia, affecting approximately 8% of asymptomatic patients, is linked to elevated bleeding and mortality risks.
  • Traditional reliance on specific platelet count thresholds for procedures is challenged by the variable correlation between platelet counts, function, and bleeding risk.

Purpose of the Study:

  • To review current developments and trends in the perioperative management of thrombocytopenia.
  • To explore strategies for optimizing platelet counts and managing bleeding risks in patients undergoing surgery.

Main Methods:

  • Review of large contemporary database studies.
  • Analysis of evidence for prophylactic platelet transfusion and alternative management options.
  • Evaluation of intraoperative adjuncts and pharmacologic interventions.

Main Results:

  • Prophylactic platelet transfusion evidence is limited, with common refractoriness.
  • Platelet count thresholds may not accurately predict bleeding risk, which is influenced by platelet function and etiology.
  • Pharmacologic options like steroids, IVIG, thrombopoietin receptor agonists, and monoclonal antibodies can optimize platelet counts.
  • Intraoperative strategies include desmopressin, antifibrinolytics, recombinant factor VII, prothrombin complex concentrate, fibrinogen concentrate, and cryoprecipitate.

Conclusions:

  • High-quality evidence for many interventions is lacking, necessitating further research.
  • A multidisciplinary, multimodal perioperative approach is crucial for effectively reducing bleeding risk in thrombocytopenic patients.