{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:23:21Z","timestamp":1787505801794,"version":"build-2736575974"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The anticoagulation strategy and the cardiopulmonary bypass management represent two core elements of the intraoperative care of the cardiac surgery patient. The ideal approach remains an issue of debate, though data encourage the development of a coagulation friendly environment. Our aim was to investigate the effect of intraoperative management on postoperative thrombocytopenia in cardiac surgery patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective study set at a tertiary university hospital. Patients who underwent valve and complex cardiac surgery from January 2019 to December 2021 were included. All patients were managed with Minimally Invasive Extracorporeal Circulation. Platelet count, the anticoagulation technique, hemoglobin, transfusion and bleeding data were recorded perioperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 65 patients met the inclusion criteria and were analysed. Postoperatively platelet count decreased from 208 (84) to 169 (63) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), while at 48 hours 7 patients had a platelet count &lt;80 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      .l\n                      <jats:sup>\u22121<\/jats:sup>\n                      . According to regression analysis, CPB duration and total heparin dose were independent predictors of platelet count whereas no significant correlation was found for protamine dose. After selecting for the anticoagulation technique, patients who received heparin concentration monitoring had significantly lower relative decline in platelet count at 48 hours (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.04), received a higher total heparin dose (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03) but were given less protamine (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Overall, the frequency of transfusion was low and a trend toward less RBC transfusion was recorded when heparin-level concentration was used (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.051).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Strict heparin-level concentration monitoring combined with Minimally Invasive Extracorporeal circulation may have contributed to a coagulation-friendly cardiac surgery translating into a low incidence of thrombocytopenia and transfusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261479246","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T06:06:36Z","timestamp":1787205996000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors contributing to thrombocytopenia after cardiac surgery; towards defining coagulation-friendly cardiac surgery"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7448-420X","authenticated-orcid":false,"given":"Anna","family":"Gkiouliava","sequence":"first","affiliation":[{"name":"AHEPA University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despoina G.","family":"Sarridou","sequence":"additional","affiliation":[{"name":"AHEPA University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5451-4651","authenticated-orcid":false,"given":"Polychronis","family":"Antonitsis","sequence":"additional","affiliation":[{"name":"AHEPA University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios T.","family":"Karapanagiotidis","sequence":"additional","affiliation":[{"name":"AHEPA University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Argiriadou","sequence":"additional","affiliation":[{"name":"AHEPA University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(01)01099-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15195"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.10.039"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182354b7e"},{"key":"e_1_3_3_6_2","first-page":"446","article-title":"A multidisciplinary perioperative strategy for attaining \u2018more physiologic\u2019 cardiac surgery","volume":"32","author":"Anastasiadis K","year":"2017","unstructured":"Anastasiadis K, Antonitsis P, Deliopoulos A, et al. A multidisciplinary perioperative strategy for attaining \u2018more physiologic\u2019 cardiac surgery. Perfusion (United Kingdom) 2017; 32: 446\u2013453. https:\/\/doi.org\/10.1177\/0267659117700488","journal-title":"Perfusion (United Kingdom)"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","unstructured":"Argiriadou H Antonitsis P Gkiouliava A et al.Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study. Perfusion (United Kingdom) 2019; 35(2): 138\u2013144. https:\/\/doi.org\/10.1177\/0267659119866289. Epub ahead of print.","DOI":"10.1177\/0267659119866289"},{"key":"e_1_3_3_8_2","first-page":"ezae352","article-title":"EACTS\/EACTAIC guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP","volume":"2024","author":"Casselman FPA","year":"2024","unstructured":"Casselman FPA, Lance MD, Ahmed A, et al. EACTS\/EACTAIC guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP. 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Effect of high or low protamine dosing on postoperative bleeding following heparin anticoagulation in cardiac surgery. A randomised clinical trial 2016; 116: 251\u2013261.","journal-title":"A randomised clinical trial"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2013.09.007"},{"key":"e_1_3_3_30_2","first-page":"1595","article-title":"Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery on minimal invasive extracorporeal circulation; A prospective randomized study","volume":"39","author":"Anna G","year":"2023","unstructured":"Anna G, Helena A, Polychronis A, et al. Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery on minimal invasive extracorporeal circulation; A prospective randomized study. 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