Thromb Haemost 2017; 117(10): 1887-1895
DOI: 10.1160/TH16-10-0804
Cellular Haemostasis and Platelets
Schattauer GmbH

Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery

Aida Anetsberger
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Manfred Blobner
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Bernhard Haller
2  Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Sebastian Schmid
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Katrin Umgelter
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Theresa Hager
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Clemens Langgartner
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Eberhard F. Kochs
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Karl-Ludwig Laugwitz
3  I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Bettina Jungwirth
1  Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Isabell Bernlochner
3  I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
› Author Affiliations
Further Information

Publication History

Received: 24 October 2016

Accepted after major revision: 24 June 2017

Publication Date:
08 November 2017 (online)

Summary

This study evaluates whether immature platelets (IPF) determined in the post anesthesia care unit (PACU) can predict major adverse cardiovascular events (MACE) or other thromboembolic events after intermediate and high-risk surgery. IPF are increased in patients with acute coronary syndrome and recently gained interest as novel biomarker for risk stratification. In this prospective observational trial 732 patients undergoing intermediate or high-risk non-cardiac surgery were enrolled (NCT02097602). IPF was measured preoperatively and postoperatively in the PACU. Primary outcome was a composite endpoint defined as MACE, deep vein thrombosis or pulmonary embolism during hospital stay (modMACE). A cut off for IPF identifying a threshold between a low and high risk for modMACE was calculated by logrank optimization. A multivariate Cox regression was calculated in a forward stepwise manner to assess the relation between this IPF cut off and modMACE as well as other established risk factors (inclusion if p<0.05). Preoperatively, there were no differences in IPF between patients with and without modMACE (3.1% [2.2% – 4.7%](median [interquartile range]) vs. 2.8% [1.9% – 4.3%]. Patients with modMACE (28 of 730 patients; 3.8%) had higher IPF values in the PACU compared to patients without modMACE (3.6% [2.6–6%] vs. 2.9% [2–4.4%]; p=0.011). The optimal cut off of IPF > 5.4% was associated with an increased risk for modMACE after adjustment for covariates (hazard ratio: 2.528; 95% confidence interval: 1.156 to 5.528, p=0.02). In conclusion, IPF is an independent predictor of modMACE after surgery and might improve risk stratification of surgical patients.

Institution where the work was performed and funded: Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.