Prostaglandin E1 inhibits platelet decrease after massive blood transfusions during major surgery: influence on coagulation cascade?
BACKGROUND
A plunge in platelet count if often observed after massive blood transfusions during major surgery. This study was designed to assess whether the prophylactic administration of prostaglandin E1 (PGE1) might prevent this drop in platelet count.


METHODS
Forty-five patients receiving massive transfusions of packed red blood cells (> 10 units) during major orthopedic surgery were enrolled in a prospective, randomized, double-blind, placebo-controlled study and divided into two groups: group 1 (therapy group) received intravenous PGE1 up to 30 ng/kg/min for 72 hours after surgery, and group 2 (placebo group) received a placebo during the same time period.


RESULTS
The patients in group 1 suffered no reduction in platelet count and thus required no platelet concentrate transfusions. In contrast, a significant postoperative drop in platelet count (p < 0.05) was observed in the placebo group between days 3 and 5 after surgery when compared to the therapy group, necessitating transfusions of platelet concentrates in this group. Similarly, red blood cell count and hemoglobin were far more stable in the therapy group, which required fewer transfusions of red blood cells than did the placebo group (p < 0.05). There seemed to be a tendency toward a consumptive coagulation disorder in the placebo group as indicated by a decrease of fibrinogen levels, prothrombin time, and antithrombin III activity, and an increase of partial thromboplastin time. The incidence of adult respiratory distress syndrome was slightly lower in the therapy group. Last but not least, the length of intensive care unit stay was significantly shorter in the therapy group (p < 0.05).


CONCLUSIONS
In our study, the administration of PGE1 prevented a reduction in platelet count. Furthermore, measurements of clotting activity furnished the possibility that PGE1 might inhibit transfusion-induced coagulation disturbances. We recommend that PGE1 should be considered in patients requiring massive transfusion during major surgery.
Locker
G J
GJ
Department of Internal Medicine I, University of Vienna, Vienna, Austria.
Staudinger
T
T
Knapp
S
S
Laczika
K F
KF
Burgmann
H
H
Urlicic
A
A
Wagner
A
A
Metnitz
P
P
Knoebl
P
P
Schuster
E
E
Frass
M
M
D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use*; D001777:Blood Coagulation; D001859:Bone Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D004906:Erythrocyte Count / Q000187:drug effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010976:Platelet Count / Q000187:drug effects; D017713:Platelet Transfusion; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000517:prevention & control; D013921:Thrombocytopenia / Q000517:prevention & control*; D065227:Transfusion Reaction
D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D000527:Alprostadil