Cardiopulmonary bypass-induced coagulopathy in pediatric patients: The role of platelets in postoperative bleeding. A preliminary study.

Abstract

Pediatric patients are particularly prone to cardiopulmonary bypass (CPB)-induced coagulopathy mainly due to hemodilution, consumption of coagulation factors and hypothermia. The aim of the present study was to examine the possible role of platelet count and function as it relates to the bleeding risk after CPB in the pediatric population. All consecutive patients (age <13years) scheduled for elective cardiac surgery between January 2019 and November 2019 were retrospectively considered for the study. We gathered demographic characteristics, perioperative laboratory data (mainly platelet count and function), transfusion requirements, and blood loss for each patient. Patients with a chest tube output during the first 24hours after surgery >75th percentile were bleeders (cases). Controls were nonbleeders. A total of 31 patients were enrolled [median age 17 (4-57) months]. A significant postoperative reduction in platelet count (P<.001) and function either in ADP-test (P<.001), TRAP-test (P<.001) and ASPI-test (P<.001) was found, with positive correlations between chest tube output within the first 24hours after surgery and postoperative impairment of platelet count (R=0.553, P=.001), ADP-test (R=0.543, P=.001), TRAP-test (R=0.627, P<.001) and ASPI-test (R=0.436, P=.014). Eight children (26%) experienced major postoperative bleeding. Bleeders were significantly younger (P=.015) and underwent longer CPB duration (P=.015). Despite no significant differences in postoperative platelet count and function between cases and controls, the postoperative reduction (Δ) in platelet count (P=.002) and function in ADP-test (P=.007), TRAP-test (P=.020) and ASPI-test (P=.042) was significantly greater in bleeders vs. nonbleeders. A ΔPLT >262500 ×109 /L, a ΔADP-test >29 U, a ΔTRAP-test >44 U and a ΔASPI-test >26 U showed to be predictive of major postoperative bleeding. Postoperative bleeding in children undergoing cardiac surgery with CPB was linked to younger age, longer CPB duration, and significant postoperative reduction in platelet count and function. Larger studies are needed to confirm our results and define strategies to reduce postoperative bleeding in these patients.