ABSTRACT
【Objective】 To investigate the clinical manifestations, diagnosis, differential diagnosis and management strategies of thrombocytopenia caused by tirofiban. 【Methods】 The basic clinical data, platelet count changes and treatment course of 7 patients with acute coronary syndrome who used tirofiban resulting in severe thrombocytopenia during their hospitalization in our hospital from December 2021 to March 2023 were collected, and their individual and common characteristics were analyzed. 【Results】 Platelet counts were in the normal range in all 7 patients on admission. Six of the patients had thrombocytopenia occurring from 3 to 16 hours after tirofiban use, and one patient was detected at 34 h of tirofiban use. Their minimum platelet count ranged from (1-11)×109/L. All 7 cases discontinued tirofiban and other antithrombotic drugs, and the platelet count increased to 50×109/L in 6 patients in 2 to 4 days after stopping the drug and gradually returned to the normal range. During this period, there were no bleeding or acute thrombotic events, and no platelet transfusion was conducted. Five patients resumed antithrombotic therapy when the platelet count returned to (20-50)×109/L, 1 patient underwent elective coronary artery bypass grafting (CABG) surgery when the count rose above 50×109/L. One patient had bleeding manifestations after thrombocytopenia and required limited-duration CABG surgery, so 3 U platelet transfusion and immunoglobulin treatment were performed consecutively. CABG surgery was performed when the platelet count increased to 76×109/L. The differential diagnosis of the cause of thrombocytopenia was performed in all seven patients, and other causes of thrombocytopenia, such as heparin, were excluded. 【Conclusion】 Tirofiban can cause acute severe or extremely severe thrombocytopenia. Routine platelet count testing at 6 hours after medication can prevent serious adverse events by discontinuing tirofiban promptly after thrombocytopenia occurs. At the same time, it is determined whether to perform platelet transfusion based on whether the patient has bleeding and the risk of bleeding, and the timing of resuming antithrombotic treatment is determined based on the recovery of platelet count and the risk of thrombosis.
ABSTRACT
【Objective】 To investigate the effect of optimized preoperative hemoglobin (Hb) level on clinical outcome in patients undergoing coronary artery bypass grafting (CABG). 【Methods】 Retrospective analysis was performed on patients who were selected to receive CABG from April 2020 to August 2021 in our hospital. Preoperative basic data, perioperative blood transfusion volume, blood transfusion rate, acute liver function impairment, renal function impairment (AKI), ICU stay, length of hospital stay, and in-hospital mortality of patients, meeting the inclusion criteria, were collected. According to the perioperative red blood cell transfusion, the optimal preoperative Hb threshold was calculated by receiver operating characteristic curve (ROC). According to the threshold, all patients were divided into two groups, and the blood transfusion volume and clinical outcomes of the two groups were compared to evaluate the predictive value of the optimal threshold of Hb. 【Results】 A total of 915 patients who met the inclusion criteria were enrolled in the study. The optimal threshold for predicting red blood cell transfusion rate by calculating preoperative Hb value by ROC curve was 118 g/L for males and 116g/L for females. Group A: Hb≤ threshold (n=293) was divided into the red blood cell transfusion group A1 and the red blood cell non-transfusion group A2. Group B: Hb>threshold (n=622) was divided into the red blood cell non-transfusion group B1 and no red blood cell non-transfusion group B2. The risk factors for perioperative red blood cell transfusion were age (OR=1.033 874, 95%CI 1.000 4-1.068 3, P<0.01), gender (female) (OR=3.268 5, 95%CI 2.353 1-4.540 0, P<0.01), BMI (OR=0.927 8, 95%CI 0.883 3-0.974 4, P<0.01), chronic renal insufficiency (CKD) (OR=2.041 1, 95%CI 1.347 8-3.091 0, P<0.01). Preoperative Hb≤ threshold (OR=3.517 4, 95%CI 2.502 1-4.944 7, P<0.01) was an independent risk factor for perioperative red blood cell transfusion. Perioperative red blood cell transfusion in patients with preoperative anemia further increases the incidence of postoperative complications (acute liver injury, AKI) and length of ICU stay. 【Conclusion】 Preoperative Hb≤ threshold can effectively predict perioperative red blood cell transfusion in patients with CABG, and increase the risk of postoperative acute liver injury, AKI, prolonged ICU stay and hospital stay. Optimizing the preoperative Hb level in CABG patients, increasing the Hb level to 118 g/L in males and 116 g/L in females can reduce the incidence of perioperative red blood cell transfusion and postoperative complications.