Abstract
Background:
Carotid revascularization procedures are infrequently performed in patients with mild-moderate thrombocytopenia. However, whether such procedures are associated with a higher unknown risk of peri-procedural complications such as myocardial infarction (MI)/arrhythmia, need for blood transfusions, unplanned intubations, and death. There is no large population based study available to quantify the risk after carotid endarterectomy (CEA) in patients with thrombocytopenia.
Methods:
We studied all patients who underwent CEA in the American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP) Registry between years 2011 and 2013.The ACS-NSQIP prospectively collects data on over 300 variables pertaining to patient characteristics, comorbid conditions, operative details, and 30-day post-operative outcomes. Thrombocytopenia was defined based on the pre procedure platelet count of <150,000 platelet/μL. The odds ratios for selected outcomes were calculated after adjusting for age, gender, and symptomatic status using logistic regression.
Results:
Thrombocytopenia was present in 931(10.5%) of 8835 patients who underwent CEA. Their severity of thrombocytopenia was mild (100,000-149,000 platelets/μL) and moderate (<100,000platelets/μL) in 821(88.18%) and 110(11.8%) patients, respectively. Patients with thrombocytopenia were more likely to be asymptomatic prior to CEA (54.4% vs. 45.6%; p=0.02). There was a significantly higher prevalence of MI/arrhythmia among patients with thrombocytopenia in compare to without (3.7% vs. 1.8%; odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.33-2.88; p<0.001). The incidence of unplanned intubation post CEA was higher among patients with thrombocytopenia (2.5% vs. 1.2%; p=0.004). There were no differences in the need for blood transfusions (2.5% vs. 2.4%; OR: 1.05; 95% CI: 0.67-1.64; p =0.83) and one month mortality (0.6% vs. 0.8%; OR: 0.66; 95% CI: 0.28-1.54; p=0.33) among patients with and without thrombocytopenia.
Conclusions:
The higher rate of post procedural complications in patients with thrombocytopenia needs to be recognized for appropriate risk stratification.