| ObjectiveThrombocytopenia is common in patients received cardiovascular surgeries.In many centers in China,patients in postoperative ICU are usually exposed to arteriovenous heparin flush administration again for anticoagulation.Our center has been using argatroban(an alternative anticoagulant for HIT prevention)flush for anticoagulation of catheters after cardiac surgery due to postoperative thrombocytopenia and HIT.To compare the effects of arteriovenous argatroban and heparin flushes on platelet count and assess the occurrence of heparin-induced thrombocytopenia(HIT)and other complications in patients undergoing cardiovascular surgeries.MethodsA single-center,prospective randomized control study was conducted.Patients who underwent cardiovascular surgery at Fuwai Hospital,Chinese Academy of Medical Sciences from March to December 2019 were randomly divided into the argatroban group(250 ml normal saline plus 2.5 mg of argatroban)and the heparin group(250 ml normal saline plus 10 mg of heparin).Platelet count,hemorrhage,and thrombosis were assessed.The 4T scores of HIT,the incidences of HIT and other complications were also evaluated.ResultsA total of 491 patients(307 males and 184 females)were included in the study,with a mean age of(52.3±13.7)years.There were 245 cases in the argatroban group and 246 cases in the heparin group,respectively.There was no statistically significant difference in preoperative baseline data between the Agatroban group and the heparin group(both P>0.05),and there was no statistically significant difference in the type of cardiovascular surgery(valve surgery,bypass surgery,congenital heart disease surgery,composite surgery,aortic open surgery)between the two groups(P=0.925).There was also no statistically significant difference in intraoperative platelet usage rate(P=0.622).There was no statistically significant difference in the preoperative platelet count between the argatroban and heparin groups[198.0(161.0,248.0)× 109/L vs 194.0(157.2,243.8)×109/L,P=0.498].Likewise,there were no statistically significant differences in the platelet count between the argatroban and heparin groups at 12 h,1 day,and 5 days after operation[127.0(100.0,154.0)× 109/L vs 121.5(90.2,149.0)× 109/L,126.0(97.0,162.0)× 109/L vs 123.5(88.0,151.0)× 109/L,168.0(130.0,215.0)× 109/L vs 161.0(101.0,210.5)× 109/L](repeated measures ANOVA between groups:F=3.327,P=0.069;time comparison:F=532.523,P＜0.001;time interaction between groups:F=0.675,P=0.512).The proportion of 4T scores of medium and high scores(≥4)[9.8%(24/245)vs 10.6%(26/246),P=0.777].According to the 4T scoring method,two groups with a score of≥4 are classified as medium to high.All patients with medium to high scores were tested for HIT antibodies.If HIT antibodies were negative,both groups were treated with low-dose anticoagulant therapy using Agatroban for arterial and venous flushing.If HIT antibodies were positive,the standard therapeutic dose of Agatroban anticoagulant therapy was administered(Agatroban 0.5-1.2ug/kg/min,monitoring APTT as 1.5-3.0 times the baseline value).Four cases(1.62%)in the heparin group were HIT positive,while four cases(1.63%)in the agatroban group were HIT positive.So the incidence of HIT antibody positive[1.63%(4/245)vs 1.63%(4/246),P=0.726]were similar between argatroban group and the heparin group.Mechanical ventilation time was shorter in the argatroban group than that in the heparin group[13.0(11.0,21.0)vs 15.5(12.0,21.0)h,P=0.020].The postoperative INR and APTT were significantly higher in the argatroban group than in the heparin group(P<0.001).In contrast,prothrombin activity(PTA)was significantly lower in the argatroban group that in the heparin group(P<0.001).ConclusionsCompared with heparin,routine management with argatroban for arteriovenous flush in patients who have undergone cardiovascular surgery has no significant difference.Also,Argatroban does not affect HIT,the risk of hemorrhage and thrombosis.ObjectiveThrombocytopenia is a risk factor for morbidity and mortality in critically ill patients after cardiac surgery.Stanford type A aortic dissection has a high mortality rate.At present,there is a lack of large-scale research data to evaluate the correlation between thrombocytopenia and mortality after aortic dissection.This study evaluated the association of thromboytopenia with mortality of Standford type A aortic dissection after cardiopulmonary bypass surgery.MethodsTotal of 498 patients with Standford type A aortic dissection after surgery in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2017 to December 2018 were collected retrospectively.There were 350 males and 148 females,with a mean age of(51.7±12.0)years.The patients were divided into thrombocytopenia group(platelet count<75× 109/L,n=178)and normal platelet group(platelet count≥75× 109/L,n=320)according to the lowest platelet count within 72 hours after surgery.The perioperative in-hospital mortality and related complications were calculated by univariate and multivariate logistic regression analysis.The primary endpoint was in-hospital mortality,and the secondary endpoints included secondary thoracotomy,pneumonia,postoperative continuous renal replacement therapy,paraplegia,heart failure,length of hospital stay and intensive care unit(ICU)stay time.ResultsThe morbidity of thrombocytopenia after Standford type A aortic dissection surgery was 35.7%(178/498).Univariate logistic regression analysis showed that postoperative thrombocytopenia was significantly associated with in-hospital mortality and 7 secondary endpoints(P<0.05).Multivariate logistic regression analysis showed thrombocytopenia after aortic dissection surgery was significantly associated with increased postoperative mortality(OR=12.57,95%CI:2.26-69.93,P=0.004),secondary thoracotomy(OR=6.21,95%CI:1.31-29.46,P=0.022),continuous renal replacement therapy(OR=7.51,95%CI:2.53-22.34,P<0.001),paraplegia(OR=23.99,95%CI:1.47-392.21,P=0.026),heart failure(OR=4.71,95%CI:1.19-18.62,P=0.027)and longer ICU stay time(OR=1.86,95%CI:1.11-3.12,P=0.019).At the same time,there are three related parameters of platelets:(1)platelet count/10 after aortic dissection:it is a risk factor for five end-point events,including in-hospital death,secondary thoracotomy hemostasis,continuous renal replacement therapy,paraplegia,heart failure(all P<0.05).(2)Absolute value of preoperative and postoperative changes in platelet count/10:it was a risk factor for five end-point events,including in-hospital death,second thoracotomy hemostasis,CRRT,paraplegia,and heart failure(all P<0.05).(3)The percentage of absolute value/10 of platelet count change before and after surgery:it was a risk factor for five end-point events,including in-hospital death,second thoracotomy hemostasis,CRRT,heart failure,and prolonged ICU time(all P＜0.05).The logistic inflection point value of postoperative minimum platelet count and mortality rate was 59.3× 109/L.ConclusionsThrombocytopenia after Standford type A aortic dissection after cardiopulmonary bypass surgery(the lowest platelet count within 72 hours)is strongly associated with postoperative in-hospital mortality.Trying to avoid the factors related to thrombocytopenia can prevent more complications at the same time. |
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