Immediate postoperative thrombocytopenia following elective abdominal aortic anuerysm repair and aortic vascular surgery for occlusive disease

Abstract

Ischaemia and reperfusion injury is a major problem in modern day vascular surgery. There is increased platelet adhesiveness and aggregation following aortic vascular surgery. Mortality and morbidity following aortic surgery particularly after ruptured AAA is associated with development of coagulopathy. Platelet count, white cell count, prothrombin time and activated partial thromboplastin time were monitored pre- and post-operatively in 38 patients undergoing elective aortic surgery. All patients had a fall in platelet count and all but 4 patients had a rise in white cell count. Twenty patients (38%) developed thrombocytopenia (platelet count < 130×10⁹/L, normal range in our lab 130−140×10⁹/L). The range of changes in platelet count was not significantly related to the type of operation (p = 0.3102), type of graft used (p = 0.5626) or to blood transfusion (p = 0.778). Six patients (16%) had systemic inflammatory response syndrome, of whom three died and two developed chest infections needing prolonged ITU care and antibiotics. These patients had a significant fall in platelet count (p = 0.0243). The extent of change in platelet count and white cell count may have a prognostic value.