Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.
Journal Article (Journal Article)
BACKGROUND: Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke. METHODS: We evaluated 6130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild versus moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0-1 days; delayed: ≥2 days). RESULTS: Median (interquartile range) postoperative nadir platelet counts were 123.0 (98.0-155.0) × 10/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts >150 × 10/L, 100 to 150 × 10/L, and <100 × 10/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 10/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01-1.24; P= .0255). On a given day, patients with moderate to severe thrombocytopenia were almost twice as likely to develop stroke (adjusted HR, 1.89; 95% CI, 1.13-3.16; P= .0155) as patients with nadir platelet counts >150 × 10/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2 days after surgery; adjusted HR, 2.83; 95% CI, 1.48-5.41; P= .0017) but not early postoperative stroke. CONCLUSIONS: Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.
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Duke Authors
- Aronson, Solomon
- Bottiger, Brandi Anne
- Cherry, Anne
- D'Amico, Thomas Anthony
- Gaca, Jeffrey Giles
- Ghadimi, Kamrouz
- Glower Jr., Donald D.
- Hartwig, Matthew
- Hughes IV, George Charles
- Iboaya, Ehimemen
- Karhausen, Jorn
- Levy, Jerrold Henry
- Lin, Shu Shiuh-Shi
- Manning, Michael Wayne
- Mathew, Joseph P.
- Milano, Carmelo Alessio
- Nicoara, Alina
- Onaitis, Mark William
- Podgoreanu, Mihai V.
- Smith, Peter Kent
- Stafford-Smith, Mark
- Swaminathan, Madhav
- Tong, Betty Caroline
- Welsby, Ian James
Cited Authors
- Karhausen, JA; Smeltz, AM; Akushevich, I; Cooter, M; Podgoreanu, MV; Stafford-Smith, M; Martinelli, SM; Fontes, ML; Kertai, MD
Published Date
- October 2017
Published In
Volume / Issue
- 125 / 4
Start / End Page
- 1129 - 1139
PubMed ID
- 28632537
Pubmed Central ID
- PMC5603360
Electronic International Standard Serial Number (EISSN)
- 1526-7598
Digital Object Identifier (DOI)
- 10.1213/ANE.0000000000002187
Language
- eng
Conference Location
- United States