A Novel Approach to Essential Thrombocythemia and Cardiac Surgery.

Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by persistent thrombocytosis (>450 × 109/L). Patients with ET are at risk for thrombotic or hemorrhagic complications especially during cardiovascular operations. We discuss a patient with ET requiring coronary artery bypass grafting with a presenting platelet count of 1631 × 109/L. Platelet reduction with an intraoperative autologous transfusion technique decreased the platelet count to 758 × 109/L before initiation of cardiopulmonary bypass. In addition, perioperative cangrelor therapy was administered to further limit risk of thrombotic complications. The patient had an uneventful perioperative and postoperative course.