PROSTAGLANDIN E(1) INHIBITS PLATELET DECREASE AFTER MASSIVE BLOOD-TRANSFUSIONS DURING MAJOR SURGERY - INFLUENCE ON COAGULATION CASCADE

Background: A plunge in platelet count is often observed after massive blood transfusions during major surgery, This study was designed to a ssess whether the prophylactic administration of prostaglandin E(1) (P GE(1)) might prevent this drop in platelet count. Methods: Forty-five patients receiving massive transfusions of packed red blood cells (>10 units) during major orthopedic surgery were enrolled in a prospective , randomized, double-blind, placebo-controlled study and divided into two groups: group 1 (therapy group) received intravenous PGE(1) up to 30 ng/kg/min for 72 hours after surgery, and group 2 (placebo group) r eceived a placebo during the same time period, Results: The patients i n group 1 suffered no reduction in platelet count and thus required no platelet concentrate transfusions, In contrast, a significant postope rative drop in platelet count (p<0.05) was observed in the placebo gro up between days 3 and 5 after surgery when compared to the therapy gro up, necessitating transfusions of platelet concentrates in this group, Similarly, red blood cell count and hemoglobin were far more stable i n the therapy group, which required fewer transfusions of red blood ce lls than did the placebo group (p<0.05), There seemed to be a tendency toward a consumptive coagulation disorder in the placebo group as ind icated by a decrease of fibrinogen levels, prothrombin time, and antit hrombin III activity, and an increase of partial thromboplastin time, The incidence of adult respiratory distress syndrome was slightly lowe r in the therapy group, Last but not least, the length of intensive ca re unit stay was significantly shorter in the therapy group (p<0.05), Conclusion: In our study, the administration of PGE(1) prevented a red uction in platelet count, Furthermore, measurements of clotting activi ty furnished the possibility that PGE(1) might inhibit transfusion-ind uced coagulation disturbances, We recommend that PGE(1) should be cons idered in patients requiring massive transfusion during major surgery.