From the Guidelines
Thrombocytosis is not an absolute contraindication to surgery, and the decision to proceed with surgery should be based on individualized assessment of the patient's thrombotic and bleeding risks. According to the most recent and highest quality study 1, there is no evidence to support the use of platelet transfusions or other interventions to increase platelet counts before procedures, as these measures do not substantially improve thrombin generation capacity or viscoelastic markers of bleeding risk.
Key Considerations
- The underlying cause of thrombocytosis, whether primary (essential) or reactive, plays a significant role in determining surgical risks, with primary thrombocytosis carrying higher risks 1.
- Patients with severe thrombocytosis (>1,000/μL) may require preoperative cytoreduction, often with hydroxyurea or plateletpheresis in urgent cases, to minimize the risk of thrombotic events.
- Aspirin (81-100mg daily) is commonly used for primary thrombocytosis to reduce thrombotic risk, but its use should be carefully considered in the context of surgical bleeding risks.
- Anesthesiologists and surgeons should coordinate care with hematology consultation for patients with significant thrombocytosis to optimize perioperative management, including the use of low molecular weight heparin and early mobilization to prevent thrombotic events.
Management Approach
- For mild to moderate thrombocytosis (450,000-750,000/μL), surgery can typically proceed with appropriate prophylactic measures.
- For severe thrombocytosis, preoperative cytoreduction may be necessary, and the patient's thrombotic and bleeding risks should be carefully assessed and managed.
- The use of TPO receptor agonists, such as avatrombopag and lusutrombopag, may be considered in certain cases, but their use should be guided by individualized assessment of the patient's risks and benefits.
Conclusion is not allowed, so the response ends here.
From the Research
Thrombocytosis and Surgery
- Thrombocytosis, or an elevated platelet count, can have significant implications for patients undergoing surgery 2.
- Primary thrombocytosis, a chronic clonal myeloproliferative disorder, can increase the risk of perioperative hemostatic complications, and therefore requires a detailed preoperative evaluation and therapy to lower the platelet count before surgery 2.
- In contrast, reactive thrombocytosis, a benign reactive disease, is often associated with complication-free surgeries, and may not require specific perioperative intervention if the underlying cause can be identified and there is no prior evidence of hemostatic complications 2.
Risks and Management
- Extreme thrombocytosis can increase the risk of excessive bleeding and thrombosis during cardiovascular surgical and interventional procedures 3.
- Correcting excessive thrombocytosis can typically be achieved through effective therapy, which can control thrombosis and excessive hemorrhage post-procedurally 3.
- A thorough preanesthetic checkup and implementation of basic thrombo-prophylaxis measures are recommended for all patients with a raised platelet count 2.
Prognostic Significance
- Preoperative thrombocytosis has been identified as a significant unfavorable prognostic factor for patients with resectable non-small cell lung cancer, associated with shorter overall survival and disease-free survival 4.
- Postoperative thrombocytosis can also serve as a marker for complications after urologic surgery, with a higher rate of postoperative complications observed in patients who develop thrombocytosis after surgery 5.