Are patients with Werlhof's disease at increased risk for bleeding complications when undergoing cardiac surgery?
BACKGROUND
It is generally assumed, that patients with Werlhof's disease (WD) are at increased risk for bleeding complications when undergoing cardiac surgery with extracorporeal circulation. Therefore we performed this case control study to estimate the real risk for bleeding complications of these patients.


METHODS
Between 05/95 and 07/98, ten patients with WD (eight males, two females) underwent cardiac surgery employing extracorporeal circulation (WD-group). Five of these patients with platelet counts below 80/nl were treated by immunoglobulins preoperatively. Each patient with WD was matched to five patients without WD (no-WD-group) using diagnosis, age, gender, ejection fraction, number of distal anastomosis and body-mass-index as matching criteria.


RESULTS
Mean number of platelet counts were significant lower in the WD-group than in the no-WD-group despite a significant increase of platelet counts after immunoglobulin treatment (54/nl-->112/nl, P=0.018). On the day before, directly after and on the first day after surgery they were 141/nl vs. 215/nl (P=0.012), 75/nl vs. 147/nl (P=0.001) and 93/nl vs. 136/nl (P=0.009). Accordingly, patients of the WD-group received significantly more platelet concentrates than patients of the no-WD-group (mean number of platelet concentrates: 2.3 versus 0.7, P=0.007). Total drainage loss via the mediastinal chest tubes was almost identical (1197 ml in the no-WD-group and 1140 ml in the WD-group). One patient of each group suffered from a bleeding complication requiring reexploration. Three patients of the no-WD-group (6%) and one patient of the WD-group (10%) expired postoperatively unrelated to WD.


CONCLUSIONS
Patients with WD may possibly undergo cardiac surgery without a markedly enhanced risk for bleeding complications despite a more than usual transfusion requirement and significantly lower platelet counts perioperatively.
Christiansen
S
S
Klinik und Poliklinik für Thorax-, Herz- und Gefässchirurgie, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany.
Rötker
J
J
Roeder
N
N
Jahn
U R
UR
Stypmann
J
J
Scheld
H H
HH
Schmid
C
C
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy
D007136:Immunoglobulins