Postoperative thrombocytopenia: why you should consider antiplatelet therapy?

Purpose of review This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. Recent findings Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state and contribute to acute organ failure. Summary For over 6 decades, major postoperative complications after cardiac surgery have remained unchanged. The potential influence of microthrombosis involving platelets has been underappreciated and use of perioperative antiplatelet therapy remains very limited – primarily because of a culture of fear of bleeding. Correspondence to Manuel L. Fontes, MD, Professor of Anesthesiology and Critical Care, Yale University School of Medicine, 333 Cedar Street, TMP-3, P.O. Box 208051, New Haven, CT 06520, USA. Tel: +1 203 785 2802; e-mail: manuel.fontes@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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