title: Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes.
abstract: BACKGROUND
  Platelet (PLT) transfusions are administered in cardiac surgery to prevent or treat bleeding, despite appreciation of the risks of blood component transfusion. The current analysis investigates the hypothesis that PLT transfusion is associated with adverse outcomes associated with coronary artery bypass graft surgery (CABG).
  
  
  METHODS
  Data originally collected during double-blind placebo-controlled phase III trials for licensure of Trasylol (aprotinin injection) were retrospectively analyzed. Adverse outcome data of patients (n = 1720) that received, and did not receive, perioperative PLT transfusion were compared. Logistic regression analysis was used to assess the association of perioperative adverse events with PLT transfusion. Propensity scoring analysis was used to verify results of the logistic regression.
  
  
  RESULTS
  Patients receiving PLTs were more likely to have prolonged hospital stays, longer surgeries, more bleeding, re-operation for bleeding, and more RBC transfusions, and less likely to have full-dose aprotinin administration. Adverse events were statistically more frequent in patients that received one or more PLT transfusion. Logistic regression analysis showed that PLT transfusion was associated with infection, vasopressor use, respiratory medication use, stroke, and death. Propensity scoring analysis confirmed the risk of PLT transfusion.
  
  
  CONCLUSIONS
  PLT transfusion in the perioperative period of CABG was associated with increased risk for serious adverse events. PLT transfusion may be a surrogate marker for sicker patients and have no causal role in the outcomes observed. However, a direct contribution to outcomes remains possible.
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond, Virginia 23298-0695, USA. bdspiess@hsc.vcu.edu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Spiess
authors.forename: David
authors.initials: D
authors.lastname: Royston
authors.forename: Jerrold H
authors.initials: JH
authors.lastname: Levy
authors.forename: Jane
authors.initials: J
authors.lastname: Fitch
authors.forename: Wulf
authors.initials: W
authors.lastname: Dietrich
authors.forename: Simon
authors.initials: S
authors.lastname: Body
authors.forename: John
authors.initials: J
authors.lastname: Murkin
authors.forename: Andrea
authors.initials: A
authors.lastname: Nadel
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology
chemical_list: D007611:Aprotinin