Perioperative thrombocytopenia

Purpose of review In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia. Recent findings Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic platelet transfusion is limited and refractoriness to platelet transfusion is common. A number of options exist to optimize platelet counts prior to procedures, which include steroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and monoclonal antibodies. In addition, intraoperative alternatives and adjuncts to transfusion should be considered. It appears reasonable to use prophylactic desmopressin and antifibrinolytic agents, whereas activated recombinant factor VII could be considered in severe bleeding. Other options include enhancing thrombin generation with prothrombin complex concentrate or increasing fibrinogen levels with fibrinogen concentrate or cryoprecipitate. Given the lack of good quality evidence, much research remains to be done. However, with a multidisciplinary multimodal perioperative strategy, the risk of bleeding can be decreased effectively.

Automated summary

In this review, recent developments in the perioperative management of thrombocytopenia are discussed, highlighting the challenges of predicting bleeding risk based solely on platelet counts and the need for individualized approaches. Prophylactic platelet transfusion may not always be supported by evidence, and alternative measures such as desmopressin, antifibrinolytic agents, and other hemostatic agents should be considered. More research is needed to further refine perioperative strategies for managing thrombocytopenia and reducing bleeding risk.