Storage duration of platelet concentrates and clinical outcomes in cardiac surgery patients
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Published on: December 7, 2012
Fabienne M A van Hout1,2, Camila Caram-Deelder1, Aad Pors1
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Longer storage duration of platelets (4-7 days) is linked to increased in-hospital mortality, greater blood loss, and more reoperations for bleeding in cardiac surgery patients compared to shorter storage (1-3 days).
Area of Science:
- Transfusion Medicine
- Hematology
- Cardiac Surgery
Background:
- Platelet storage lesion refers to changes in platelet function and structure post-collection and storage.
- These changes may lead to impaired hemostasis and adverse events in patients.
- A retrospective study was conducted on cardiac surgery patients transfused between 2005 and 2017.
Purpose of the Study:
- To investigate the association between platelet storage duration and clinical outcomes in cardiac surgery patients.
- To determine if longer storage duration impacts in-hospital mortality, postoperative blood loss, and reoperation rates.
Main Methods:
- Retrospective analysis of cardiac surgery patients transfused with platelets.
- Platelet concentrates categorized as shorter storage duration (PSSD; 1-3 days) or longer storage duration (PLSD; 4-7 days).
- Logistic regression analysis adjusted for confounders to assess associations between storage duration and outcomes.
Main Results:
- Patients receiving PLSD had significantly higher in-hospital mortality (10.0% vs 7.6%) compared to PSSD.
- PLSD transfusion was associated with significantly more postoperative blood loss (≥1000 mL) (35.8% vs 26.7%).
- Reoperation for bleeding was significantly higher in patients receiving PLSD (34.7% vs 26.7%).
Conclusions:
- Transfusion of platelets with longer storage duration (PLSD) is associated with adverse outcomes in cardiac surgery patients.
- Specifically, PLSD is linked to increased in-hospital mortality, greater blood loss, and a higher need for reoperation due to bleeding.
- Shorter storage duration platelets (PSSD) appear to be associated with better outcomes in this patient population.
Background:
The changes in platelet structure and function arising from its collection and storage are collectively called "platelet storage lesion." In patients this might potentially be associated with impaired hemostasis and adverse events. We performed a hypothesis-generating retrospective study in cardiac surgery patients transfused with platelets in two hospitals between 2005 and 2017.
Study Design And Methods:
We explored whether longer storage duration of platelets is associated with changes in in-hospital mortality, blood loss after surgery, reoperation for bleeding, stroke, myocardial infarction, infection, systemic inflammatory response syndrome, shock, and multi-organ failure in cardiac surgery patients. Platelet concentrates were classified as platelets with shorter storage duration (PSSD; stored 1-3 days) or platelets with longer storage duration (PLSD; stored 4-7 days). Associations between storage duration and endpoints were quantified using logistic regression adjusted for potential confounders.
Results:
In patients transfused with PLSD, in-hospital mortality (212/2117; 10.0%) was significantly higher than in patients transfused with PSSD (109/1439; 7.6%) (adjusted odds ratio [aOR] 1.47, 95% confidence interval [CI] 1.13-1.91). Patients transfused with PLSD experienced postoperative blood loss ≥1000 mL (102/285; 35.8%) significantly more frequently than patients transfused with PSSD (87/326; 26.7%), aOR 1.74 (95% CI 1.19-2.52). In patients transfused with PLSD, the need for reoperation for bleeding (99/285; 34.7%) was significantly higher than in patients transfused with PSSD (87/326; 26.7%) (aOR 1.62, 95% CI 1.12-2.35). There was no notable association with other endpoints.
Conclusion:
In cardiac surgery patients, transfusion of PLSD was associated with higher in-hospital mortality, more blood loss, and reoperations for bleeding, compared to transfusion of PSSD.
