Coronary artery bypass in idiopathic thrombocytopenia without splenectomy

Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001.
The Annals of Thoracic Surgery (Impact Factor: 3.85). 12/1989; 48(5):721-2. DOI: 10.1016/0003-4975(89)90804-7
Source: PubMed


A patient with coronary artery disease and idiopathic thrombocytopenia purpura underwent coronary artery bypass grafting without splenectomy. Our experience indicates that use of cardiopulmonary bypass in patients with idiopathic thrombocytopenic purpura does not invariably mandate splenectomy.

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    • "Study Patients Platelet count on admission (/μl) Treatment Preoperative platelet count (/μl) Procedure Grafts number Bleedings Age (years) Sex STER IVIG PC SPLE Thompson et al. (1989) [5] 61 M 68,000 • 68,000 On-pump 3 Major Koike et al. (1989) [6] 37 M 8000 • • • n.a. On-pump 3 No Bowman (1990) [7] 53 F 65,000 • • 65,000 On-pump 2 No Terada et al. (1990) [8] n.a. "
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    ABSTRACT: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. Although relatively rare, the association of ITP and coronary artery disease represents a complex therapeutic challenge. In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention.
    Preview · Article · May 2011 · Interactive Cardiovascular and Thoracic Surgery
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    • "According to previous reports [4] [5] [8], lower platelet counts beside the deleterious effects of extracorporeal circulation on platelets, necessity of full anticoagulation and impaired function of circulating platelets were suggested to be responsible for an increased risk of postoperative bleeding complications, reexplorations and transfusion of blood products. Because conservative therapy of WD, consisting of corticosteroids and/or immunosuppressive treatment, was rarely successful with regard to normalization of platelet counts and regression of symptoms, several strategies were described to reduce the risk of WD patients for postoperative bleeding complications: Splenectomy was proposed as simultaneous procedure or prior to cardiac surgery [4] [5]. "
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    ABSTRACT: It is generally assumed, that patients with Werlhof's disease (WD) are at increased risk for bleeding complications when undergoing cardiac surgery with extracorporeal circulation. Therefore we performed this case control study to estimate the real risk for bleeding complications of these patients. Between 05/95 and 07/98, ten patients with WD (eight males, two females) underwent cardiac surgery employing extracorporeal circulation (WD-group). Five of these patients with platelet counts below 80/nl were treated by immunoglobulins preoperatively. Each patient with WD was matched to five patients without WD (no-WD-group) using diagnosis, age, gender, ejection fraction, number of distal anastomosis and body-mass-index as matching criteria. Mean number of platelet counts were significant lower in the WD-group than in the no-WD-group despite a significant increase of platelet counts after immunoglobulin treatment (54/nl-->112/nl, P=0.018). On the day before, directly after and on the first day after surgery they were 141/nl vs. 215/nl (P=0.012), 75/nl vs. 147/nl (P=0.001) and 93/nl vs. 136/nl (P=0.009). Accordingly, patients of the WD-group received significantly more platelet concentrates than patients of the no-WD-group (mean number of platelet concentrates: 2.3 versus 0.7, P=0.007). Total drainage loss via the mediastinal chest tubes was almost identical (1197 ml in the no-WD-group and 1140 ml in the WD-group). One patient of each group suffered from a bleeding complication requiring reexploration. Three patients of the no-WD-group (6%) and one patient of the WD-group (10%) expired postoperatively unrelated to WD. Patients with WD may possibly undergo cardiac surgery without a markedly enhanced risk for bleeding complications despite a more than usual transfusion requirement and significantly lower platelet counts perioperatively.
    Full-text · Article · Oct 2000 · European Journal of Cardio-Thoracic Surgery
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    ABSTRACT: Reports of patients with idiopathic thrombocytopenic purpura (ITP) undergoing cardiac surgery are rare, and almost all of the reported cases required platelet transfusion. ITP patients, especially those having a history of splenectomy or a history of heavy bleeding, may have to undergo multiple platelet transfusions. Such transfusions may induce alloimmunization against the human leukocyte antigen (HLA) and result in refractoriness to subsequent platelet transfusions. We report a case of a 63-year-old female with ITP, with a history of splenectomy and multiple platelet transfusions, who underwent aortic and mitral valve replacement. Although corticosteroid administration, high-dose immunoglobulin therapy, and repeated platelet transfusion led to a temporary increase in platelet count and successful hemostasis, refractoriness to platelet transfusion occurred postoperatively because of the presence of the anti-HLA antibody. In addition, the patient showed complications of pyothorax. Corticosteroids might have exerted an inhibitory influence on the occurrence of pyothorax.
    No preview · Article · Sep 1985 · Journal of Cardiac Surgery
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