Are patients with Werlhof's disease at increased risk for bleeding complications when undergoing cardiac surgery?

Background: It is generally assumed, that patients with Werlhof's disease ( WD) are at increased risk for bleeding complications when undergoing cardia c surgery with extracorporeal circulation. Therefore we performed this case control study to estimate the real risk for bleeding complications of thes e patients. Methods: Between 05/95 and 07/98, ten patients with WD (eight m ales, two females) underwent cardiac surgery employing extracorporeal circu lation (WD-group). Five of these patients with platelet counts below 80/nl were treated by immunoglobulins preoperatively. Each patient with WD was ma tched to five patients without WD (no-WD-group) using diagnosis, age, gende r, ejection fraction, number of distal anastomosis and body-mass-index as m atching criteria. Results: Mean number of platelet counts were significant lower in the WD-group than in the no-WD-group despite a significant increas e of platelet counts after immunoglobulin treatment (54/nl --> 112/nl, P = 0.018). On the day before, directly after and on the first day after surger y they were 141/nl vs. 215/nl (P = 0.012), 75/nl vs. 147/nl (P = 0.001) and 93/nl vs. 136/nl (P = 0.009). Accordingly, patients of the WD-group receiv ed significantly more platelet concentrates than patients of the no-WD-grou p (mean number of platelet concentrates: 2.3 versus 0.7, P = 0.007). Total drainage loss via the mediastinal chest tubes was almost identical (1197 ml in the no-WD-group and 1140 ml in the WD-group). One patient of each group suffered from a bleeding complication requiring reexploration. Three patie nts of the no-WD-group (6%) and one patient of the WD-group (10%) expired p ostoperatively unrelated to WD. Conclusions: Patients with WD may possibly undergo cardiac surgery without a markedly enhanced risk for bleeding compl ications despite a more than usual transfusion requirement and significantl y lower platelet counts perioperatively. (C) 2000 Elsevier Science B.V. All rights reserved.