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. 2024 Nov;46 Suppl 5(Suppl 5):S3-S7.
doi: 10.1016/j.htct.2023.06.005. Epub 2023 Jul 31.

Characteristics of the post-surgical decrease in platelet counts in orthopedic surgery patients, observations and insights

George Zacharia  1 , Bartosz Walczyszyn  1 , Kolton Smith  2 , Guillaume Stoffels  3 , Colette Spaccavento  1 , Randy Levine  1
Affiliations

Characteristics of the post-surgical decrease in platelet counts in orthopedic surgery patients, observations and insights

George Zacharia et al. Hematol Transfus Cell Ther. 2024 Nov.

Abstract

Introduction: A reduced platelet count (PLT) is a frequent post-operative finding in orthopedic surgery patients. Despite its prevalence, the characteristics of post-surgical thrombocytopenia have not been well described.

Methods: A retrospective chart review was conducted on patients who underwent a knee or hip replacement from 2012 to 2015. Patients who received heparin were excluded.

Results: A total of 56 patients were analyzed on post-operative days 0 to 4. By day 1, 90.9% of the patients experienced a reduction in their platelet counts. The lowest mean platelet count (nadir) occurred on day 2 (201.3 × 109/L). The average decrease in the platelet count from the baseline was 24% (95%CI: 20.6 - 27.2). The change in the platelet count from the baseline ranged from a 49.6% drop to a 14.2% increase. A substantial portion of patients experienced thrombocytopenia, with 28% occurring on day 2. Platelet counts less than 100 × 109/L occurred only once. The percent decrease in the platelet count from the baseline to any other time point was significantly larger in patients aged > 65 years, compared to patients aged ≤ 65 years (p = 0.007). Specifically, the average drop in the platelet count at the nadir (day 2) relative to the baseline was 27.8% in patients aged > 65 years, compared to 19.5% in patients aged ≤ 65 years.

Conclusions: A reduction in the platelet count is a frequent post-operative finding in orthopedic surgery patients, even after removing confounding factors, such as heparin exposure, but clinical thrombocytopenia is uncommon. Alternative etiologies should be considered when the platelet count is less than 100 × 109/L. Vigilance should also be considered regarding elderly patients.

Keywords: Nadir; Orthapedic; Post-Op; Thrombophilia.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trend of post-operative platelet counts. The mean platelet count at nadir (day 2) differed significantly from baseline mean count, from day 1 mean count and day 4 mean count.
Figure 2
Figure 2
Trend of post-operative WBC counts. The mean WBC count significantly increased from day 0 to day 1.
Figure 3
Figure 3
Relationship between change in WBC count and change in platelet count. There was a significant positive relationship between change in WBC count from baseline to day 1 and change in platelet count from baseline to day 1.
Figure 4
Figure 4
Sample mean profiles for platelet count in patients aged ≤ 65 years vs. > 65 years. The percent decrease in platelet count from baseline to any other time point (day 1 to day 4) was significantly larger in patients aged > 65 years, compared to patients aged ≤ 65 years.
See this image and copyright information in PMC

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