Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.
Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.
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DOI：
10.1213/ane.0000000000002187
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发表时间：
2017-10
影响因子：
5.7
通讯作者：
Kertai MD
中科院分区：
文献类型：
--
作者：
Karhausen JA;Smeltz AM;Akushevich I;Cooter M;Podgoreanu MV;Stafford-Smith M;Martinelli SM;Fontes ML;Kertai MD
血小板计数下降可能揭示血小板活化和聚集在术后血栓形成前状态。因此，我们假设无泵冠状动脉旁路移植术（CABG）术后最低血小板计数与卒中有关。我们评估了6130例成人冠脉搭桥手术患者。术后血小板计数作为卒中的连续和分类（轻度vs.中度至重度）预测指标进行评估。采用随时间变化的协变量对术后每日最小血小板计数进行扩展Cox比例风险回归分析，评估术后血小板计数每日变化与中风发生时间的关系。竞争风险比例风险回归模型检验了术后血小板计数的日常变化与中风发生时间（早期：0-1天；延迟：≥2天）之间的关系。术后最低血小板计数中位数[四分位数间距]为123.0 [98.0,155.0]× 109/L。血小板计数、>150×109/L、100-150×109 /L和<100×109/L组术后卒中发生率分别为1.09%、1.50%和3.02%。术后某一天，血小板计数每下降30 × 109/L，卒中风险增加12%（校正风险比[HR]， 1.12； 95%可信区间[CI]， 1.01-1.24； P=0.0255）。在某一天，中度至重度血小板减少患者发生卒中的可能性是血小板计数最低的患者的两倍（调整后危险度，1.99;95% CI, 1.18-3.34； P=0.0093）。重要的是，这种血小板减少被定义为一个时变协变量，与延迟（术后≥2天；调整后风险比，2.87;95% CI, 1.49-5.55； P=0.0016）显著相关，但与术后早期卒中无关。我们的研究结果表明，中度至重度术后血小板减少症与术后卒中和冠脉搭桥术后卒中时间之间存在独立关联。
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. We evaluated 6,130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild vs. 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). Median [interquartile range] postoperative nadir platelet counts were 123.0 [98.0, 155.0] × 109/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts, >150×109/L, 100–150×109/L, and <100×109/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 109/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01–1.24; P=0.0255). On a given day, patients with moderate to severe thrombocytopenia were twice as likely to develop stroke (adjusted HR, 1.99; 95% CI, 1.18–3.34; P=0.0093) as patients with nadir platelet counts >150×109/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2days after surgery; adjusted HR, 2.87; 95% CI, 1.49–5.55; P=0.0016), but not early postoperative stroke. Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.