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Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.

Publication ,  Journal Article
Karhausen, JA; Smeltz, AM; Akushevich, I; Cooter, M; Podgoreanu, MV; Stafford-Smith, M; Martinelli, SM; Fontes, ML; Kertai, MD
Published in: Anesth Analg
October 2017

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.

Duke Scholars

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Author Solomon Aronson Anesthesiology, Cardiothoracic
Anne Cherry
Author Anne Cherry Anesthesiology
Carmelo Alessio Milano
Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery
Betty Caroline Tong
Author Betty Caroline Tong Surgery, Cardiovascular and Thoracic Surgery
Shu Shiuh-Shi Lin
Author Shu Shiuh-Shi Lin Surgery, Cardiovascular and Thoracic Surgery
Jeffrey Giles Gaca
Author Jeffrey Giles Gaca Surgery, Cardiovascular and Thoracic Surgery
Jerrold Henry Levy
Author Jerrold Henry Levy Anesthesiology, Cardiothoracic
Mark William Onaitis
Author Mark William Onaitis Surgery, Cardiovascular and Thoracic Surgery
George Charles Hughes IV
Author George Charles Hughes IV Surgery, Cardiovascular and Thoracic Surgery
Joseph P. Mathew
Author Joseph P. Mathew Anesthesiology, Cardiothoracic
Ian James Welsby
Author Ian James Welsby Anesthesiology, Cardiothoracic
Ehimemen Iboaya
Author Ehimemen Iboaya Anesthesiology, Critical Care Medicine
Michael Wayne Manning
Author Michael Wayne Manning Anesthesiology, General, Vascular, High Risk Transplant & Cr ...
Alina Nicoara
Author Alina Nicoara Anesthesiology, Cardiothoracic
Matthew Hartwig
Author Matthew Hartwig Surgery, Cardiovascular and Thoracic Surgery
Madhav Swaminathan
Author Madhav Swaminathan Anesthesiology, Cardiothoracic
Peter Kent Smith
Author Peter Kent Smith Surgery, Cardiovascular and Thoracic Surgery
Kamrouz Ghadimi
Author Kamrouz Ghadimi Anesthesiology, Cardiothoracic
Thomas Anthony D'Amico
Author Thomas Anthony D'Amico Surgery, Cardiovascular and Thoracic Surgery
Brandi Anne Bottiger
Author Brandi Anne Bottiger Anesthesiology, Cardiothoracic
Donald D. Glower Jr.
Author Donald D. Glower Jr. Surgery, Cardiovascular and Thoracic Surgery
Igor Akushevich
Author Igor Akushevich Social Science Research Institute
Mihai V. Podgoreanu
Author Mihai V. Podgoreanu Anesthesiology, Cardiothoracic
Mark Stafford-Smith
Author Mark Stafford-Smith Anesthesiology, Cardiothoracic
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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

October 2017

Volume

125

Issue

4

Start / End Page

1129 / 1139

Location

United States

Related Subject Headings

  • Stroke
  • Retrospective Studies
  • Postoperative Complications
  • Platelet Count
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Bypass, Off-Pump
  • Anesthesiology
 

Citation

APA
Chicago
ICMJE
MLA
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Karhausen, J. A., Smeltz, A. M., Akushevich, I., Cooter, M., Podgoreanu, M. V., Stafford-Smith, M., … Kertai, M. D. (2017). Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery. Anesth Analg, 125(4), 1129–1139. https://doi.org/10.1213/ANE.0000000000002187
Karhausen, Jörn A., Alan M. Smeltz, Igor Akushevich, Mary Cooter, Mihai V. Podgoreanu, Mark Stafford-Smith, Susan M. Martinelli, Manuel L. Fontes, and Miklos D. Kertai. “Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.Anesth Analg 125, no. 4 (October 2017): 1129–39. https://doi.org/10.1213/ANE.0000000000002187.
Karhausen JA, Smeltz AM, Akushevich I, Cooter M, Podgoreanu MV, Stafford-Smith M, et al. Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery. Anesth Analg. 2017 Oct;125(4):1129–39.
Karhausen, Jörn A., et al. “Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.Anesth Analg, vol. 125, no. 4, Oct. 2017, pp. 1129–39. Pubmed, doi:10.1213/ANE.0000000000002187.
Karhausen JA, Smeltz AM, Akushevich I, Cooter M, Podgoreanu MV, Stafford-Smith M, Martinelli SM, Fontes ML, Kertai MD. Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery. Anesth Analg. 2017 Oct;125(4):1129–1139.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

October 2017

Volume

125

Issue

4

Start / End Page

1129 / 1139

Location

United States

Related Subject Headings

  • Stroke
  • Retrospective Studies
  • Postoperative Complications
  • Platelet Count
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Bypass, Off-Pump
  • Anesthesiology