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Bianco V, Aranda-Michel E, Serna-Gallegos D, Dunn-Lewis C, Wang Y, Thoma F, Navid F, Sultan I. Transfusion of non-red blood cell blood products does not reduce survival following cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:243-253.e5. [PMID: 35337681 DOI: 10.1016/j.jtcvs.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The literature supports the assertion that patients undergoing cardiac surgery who receive perioperative packed red blood cell (pRBC) transfusions have increased associated mortality. The aim of the current study is to assess whether there is an association between non-pRBC blood product transfusions and increased mortality. METHODS Data from our center's Society of Thoracic Surgeons database included patients who underwent cardiac surgery from 2010 to 2018. Patients with pRBC transfusions or circulatory arrest were excluded. Propensity matching was performed (1:1; caliper = 0.2 times the standard deviation of logit of propensity score). Kaplan-Meier estimates and Cox regression were used. Cardiac transplant, ventricular assist devices, transcatheter aortic valves, and patients who had experienced circulatory arrest were excluded from this analysis. RESULTS A total of 8042 patients met criteria for analysis. Following propensity matching (1:1), 395 patients requiring perioperative non-pRBC blood products (platelets, fresh-frozen plasma, and cryoprecipitate) were matched with 395 nontransfusion patients, yielding equitable patient cohorts. Median follow-up was 4.5 (3.0-6.4) years. Patients received platelets (327 [82.8%]), fresh-frozen plasma (141 [35.7%]), and cryoprecipitate (60 [15.2%]). There was no significant difference in the postoperative mortality (6 [1.5%] vs 4 [1.0%]; P = .52). Reoperation (20 [5.0%] vs 8 [2.0%]; P < .02) and prolonged ventilation (36 [9.1%] vs 19 [4.8%]; P < .02) were greater in the transfusion group. Emergent operation (odds ratio [OR] 2.86 [1.72-4.78]; P < .001), intra-aortic balloon pump (OR 3.24 [1.64-6.39]; P < .001), and multivalve operation (OR 4.34 [2.83-6.67]; P < .001) were significantly associated with blood product use. Blood product transfusion (hazard ratio; 1.15 [0.89-1.48]; P = .3) was not significantly associated with increased mortality risk. There was no significant long-term survival difference between cohorts. CONCLUSIONS Patients who undergo cardiac surgery requiring blood products alone, without pRBC transfusion, have similar postoperative and long-term survival compared with patients not requiring blood products. These data are based on a limited patient sample, and future studies will aid in improving the generalizability of these results.
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Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Courtenay Dunn-Lewis
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Yanagawa B, Ribeiro R, Lee J, Mazer CD, Cheng D, Martin J, Verma S, Friedrich JO. Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2021; 111:607-614. [DOI: 10.1016/j.athoracsur.2020.04.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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Esper SA, Wallisch WJ, Ryan J, Sanchez P, Sciortino C, Murray H, Arlia P, D'Cunha J, Mahajan A, Triulzi D, Subramaniam K. Platelet transfusion is associated with 90-day and 1-year mortality for adult patients requiring veno-arterial extracorporeal membrane oxygenation. Vox Sang 2020; 116:440-450. [PMID: 33215723 DOI: 10.1111/vox.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies examining one-year mortality respecting component blood transfusion are sparse. We hypothesize that component blood product transfusions are negatively associated with 90-day and 1-year survival for all patients requiring veno-arterial (VA) or veno-venous (VV) ECMO. STUDY DESIGN AND METHODS This was an IRB-approved retrospective cohort analysis of 676 consecutive patients requiring ECMO at the University of Pittsburgh between 2005 and 2016. Patients were analysed both as an entire cohort and as two subsets with respect to ECMO modality (VA vs. VV). Additional data collected and analysed included patient characteristics, laboratory values and blood product transfusion. RESULTS Multivariable analysis revealed that platelet transfusion was associated with 90-day mortality (OR: 1·05, P = 0·037) and one-year mortality for the entire cohort (OR = 1·05, P = 0·046,). Platelet transfusion volume was also associated with mortality in the VA-ECMO subset of patients at both 90 days (OR = 1·08, P = 0·03) and one year (OR: 1·11, P = 0·014). Age, peak International Normalized Raton ECMO, nadir haemoglobin (on ECMO) and final haemoglobin (after ECMO) were significantly associated with mortality for patients requiring VA-ECMO. For VV-ECMO patients, age, INR and peak creatinine on ECMO were associated with mortality. No individual component blood product was associated with one-year mortality for patients requiring VV-ECMO. CONCLUSION Platelet transfusion was associated with increased 90-day and 1-year mortality for patients requiring VA-ECMO.
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Affiliation(s)
- Stephen A Esper
- Cardiovascular and Thoracic Division, Director, Department of Anesthesiology and Perioperative Medicine, UPMC Center for Perioperative Care, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - William John Wallisch
- Department of Anesthesiology, University of Kansas Hospital, Kansas City, Kansas, USA
| | - John Ryan
- Department of Cardiothoracic Surgery, UPMC, Pittsburgh, PA, USA
| | - Pablo Sanchez
- Department of Cardiothoracic Surgery, UPMC, Pittsburgh, PA, USA
| | | | - Holt Murray
- Cardiothoracic Intensive Care Unit, Department of Critical Care Medicine, UPMC Presbyterian University Hospital, UPMC, Pittsburgh, PA, USA
| | - Peter Arlia
- Department of Perfusion Medicine, UPMC, Pittsburgh, PA, USA
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, UPMC, Pittsburgh, PA, USA
| | - Darrell Triulzi
- Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Dual antiplatelet therapy up to the time of non-elective coronary artery bypass grafting with prophylactic platelet transfusion: is it safe? J Cardiothorac Surg 2019; 14:202. [PMID: 31775803 PMCID: PMC6880414 DOI: 10.1186/s13019-019-1028-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/18/2019] [Indexed: 01/17/2023] Open
Abstract
Background Guidelines suggest that patients discontinue Clopidogrel at least 5 days prior to coronary artery bypass grafting (CABG). Those with acute coronary syndrome (ACS) are at high risk for myocardial infarction (MI) if not treated with dual antiplatelet therapy (DAPT). We sought to assess pre and post-operative outcomes of patients maintained on Clopidogrel and aspirin up to the time of surgery and compare them with those on aspirin alone. Methods From the cardiac surgery database, 240 patients were retrospectively registered between January and May 2017. There were 126 patients with ACS who underwent CABG on DAPT (Clopidogrel group [CG]) and 114 patients who underwent elective CABG on aspirin alone (control). The CG received intraoperative prophylactic platelet transfusion (PPT). Demographics, comorbidities, and laboratory data were prospectively entered at the time of surgery and were subsequently retrieved for analysis. Per and postoperative findings were identified and compared between both groups. Results The cohort consisted of 240 patients (mean age 61 years, 81.3% were male, SD ± 9.58). Patients in the CG were younger (Median 57 vs. 63, P-value 0.001), and with male predominance (86% versus 75%, P-value 0.028). In addition, they had less prevalence for diabetes and renal failure as compared to control (P-values 0.003, and 0.005, respectively). There were no significant differences between both groups in number of vessels grafts, duration of on-pump and aortic clamp. Hematologic laboratory data had also similar baseline values. The CG had similar bleeding rate, redo surgery and in-hospital death (P-values non-significant), however more infection and total hospital stay as compared to control (p-values 0.048 and 0.001). Conclusion Patients who are at increased risk for MI can be maintained on DAPT up to the time of CABG because surgery is safe when patients are offered PPT.
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5
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Ning S, Liu Y, Barty R, Cook R, Rochwerg B, Iorio A, Warkentin TE, Heddle NM, Arnold DM. The association between platelet transfusions and mortality in patients with critical illness. Transfusion 2019; 59:1962-1970. [DOI: 10.1111/trf.15277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Shuoyan Ning
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Yang Liu
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Rebecca Barty
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Richard Cook
- Department of Statistics and Actuarial ScienceUniversity of Waterloo Waterloo Ontario Canada
| | - Bram Rochwerg
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Impact and EvidenceMcMaster University Hamilton Ontario Canada
| | - Alfonso Iorio
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Impact and EvidenceMcMaster University Hamilton Ontario Canada
| | - Theodore E. Warkentin
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Nancy M. Heddle
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Donald M. Arnold
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Canadian Blood Services Hamilton Ontario Canada
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6
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Zhou X, Fraser CD, Suarez-Pierre A, Crawford TC, Alejo D, Conte JV, Lawton JS, Fonner CE, Taylor BS, Whitman GJ, Salenger R. Variation in Platelet Transfusion Practices in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:134-143. [DOI: 10.1177/1556984519836839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Although the morbidity associated with red blood cell transfusion in cardiac surgery has been well described, the impacts of platelet transfusion are less clearly understood. Given the conflicting results of prior studies, we sought to investigate the impact of platelet transfusion on outcomes after cardiac surgery across institutions in Maryland. Methods Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative, we retrospectively analyzed data from 10,478 patients undergoing isolated coronary artery bypass across 10 centers. Platelet transfusion practices were compared between institutions. Multivariate logistic regression model was used to analyze the association between platelet transfusion and 30-day mortality and postoperative complications. Results Rates of platelet transfusion varied between institutions from 4.4% to 24.7% ( P < 0.001), a difference that remained statistically significant in propensity score–matched cohorts. Among patients on preoperative antiplatelet therapy, transfusion rates varied from 8.5% to 46.4% ( P < 0.001). There was no statistically significant relationship between case volume and transfusion rates ( P = 0.815). In multivariate logistic regression, platelet transfusion was associated with increased risk of 30-day mortality (OR 2.43, P = 0.008), postoperative pneumonia (OR 2.21, P = 0.004), prolonged intubation (OR 2.05, P < 0.001), and readmission (OR 1.43, P = 0.039). Conclusions Significant variation existed in platelet transfusion rates between institutions, even after controlling for various risk factors. This variation may be associated with increased mortality and length of stay. Further study is warranted to better understand risks associated with platelet transfusion. Standardizing practice may help reduce risk and conserve resources.
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Affiliation(s)
- Xun Zhou
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Charles D. Fraser
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Todd C. Crawford
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Diane Alejo
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John V. Conte
- Division of Cardiac Surgery, Penn State University Hershey Medical Center, Hershey, PA, USA
| | | | | | - Bradley S. Taylor
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Rawn Salenger
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Baltimore, MD, USA
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7
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Ninkovic S, McQuilten Z, Gotmaker R, Newcomb AE, Cole-Sinclair MF. Platelet transfusion is not associated with increased mortality or morbidity in patients undergoing cardiac surgery. Transfusion 2018. [DOI: 10.1111/trf.14561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Slavisa Ninkovic
- Department of Haematology, Pathology; St Vincent's Hospital Melbourne; Fitzroy VIC Australia
| | - Zoe McQuilten
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Melbourne VIC Australia
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - Robert Gotmaker
- Department of Anaesthesia and Acute Pain Medicine; St Vincent's Hospital Melbourne; Fitzroy VIC Australia
| | - Andrew E. Newcomb
- Department of Cardiothoracic Surgery; St Vincent's Hospital Melbourne; Fitzroy VIC Australia
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8
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Koster A, Zittermann A, Birschmann I, Gummert J. Isolated transfusion of leucocyte-depleted apheresis platelet concentrates and outcomes after cardiac surgery. Interact Cardiovasc Thorac Surg 2018; 26:155-157. [PMID: 29049543 DOI: 10.1093/icvts/ivx253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022] Open
Abstract
We investigated the association of isolated leucocyte-depleted single-donor apheresis platelet concentrate transfusion with short- and long-term outcomes of patients undergoing isolated or combined coronary artery bypass and valve surgery. Propensity score matching was used to compare the results of patients without blood product transfusion and patients with isolated platelet transfusion (n = 167 per group). The primary end-point was a composite of operative complications. Additionally, we assessed coronary reintervention and overall mortality over a follow-up period of 7.5 years. In the platelet- and platelet+ groups, the composite end-point was reached at 9.6% and 12.3%, respectively (P = 0.307). None of the patients died within 30 days. None of the patients needed coronary reintervention during follow-up. Long-term mortality was similar between groups (P > 0.05). Isolated leucocyte-depleted apheresis platelet transfusion does not appear to be associated with an increase in morbidity or mortality in non-complex cardiac surgery. However, larger studies are needed.
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Affiliation(s)
- Andreas Koster
- Institute for Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Armin Zittermann
- Clinic for Cardiothoracic Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Jan Gummert
- Clinic for Cardiothoracic Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
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Schmidt AE, Henrichs KF, Kirkley SA, Refaai MA, Blumberg N. Prophylactic Preprocedure Platelet Transfusion Is Associated With Increased Risk of Thrombosis and Mortality. Am J Clin Pathol 2017; 149:87-94. [PMID: 29228089 DOI: 10.1093/ajcp/aqx151] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We evaluated thrombosis and mortality rates of hospitalized patients receiving prophylactic platelet transfusion prior to an invasive procedure. METHODS Patient age and underlying medical condition(s), preprocedure and postprocedure platelet counts, type of procedure, number of platelet products transfused, and any complications were recorded on every prophylactic platelet given prior to an invasive procedure. RESULTS A total of 376 prophylactic transfusion recipients were identified. Nineteen (5%) thrombotic events were identified and 60 (16%) deaths occurred within 30 days of the preprocedure platelet transfusion. Most deaths were due to infection, sepsis, or organ failure, and none were due to bleeding or thrombosis. CONCLUSIONS Preprocedure platelet transfusion is associated with an increased risk of thrombosis and 30-day mortality. Whether these findings are due to higher incidences of comorbidities and confounding or to cause and effect is not determinable from these data. This study highlights an association between prophylactic platelet transfusion and thrombosis and poor outcome, including death.
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Affiliation(s)
- Amy E Schmidt
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Kelly F Henrichs
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Scott A Kirkley
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
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10
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Does a Platelet Transfusion Independently Affect Bleeding and Adverse Outcomes in Cardiac Surgery? Anesthesiology 2017; 126:441-449. [DOI: 10.1097/aln.0000000000001518] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients.
Methods
For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1:3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified.
Results
The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However, patients in the intervention group experienced less blood loss and required vasoactive medication 139 of 169 (82%) versus 370 of 507 (74%; odds ratio, 1.65; 95% CI, 1.05 to 2.58), prolonged mechanical ventilation 92 of 169 (54%) versus 226 of 507 (45%; odds ratio, 1.47; 94% CI, 1.03 to 2.11), prolonged intensive care 95 of 169 (56%) versus 240 of 507 (46%; odds ratio, 1.49; 95% CI, 1.04 to 2.12), erythrocytes 75 of 169 (44%) versus 145 of 507 (34%; odds ratio, 1.55; 95% CI, 1.08 to 2.23), plasma 29 of 169 (17%) versus 23 of 507 (7.3%; odds ratio, 2.63; 95% CI, 1.50–4.63), and platelets 72 of 169 (43%) versus 25 of 507 (4.3%; odds ratio, 16.4; 95% CI, 9.3–28.9) more often compared to the reference group.
Conclusions
In this retrospective analysis, cardiac surgery patients receiving platelet transfusion in the operating room experienced less blood loss and more often required vasoactive medication, prolonged ventilation, prolonged intensive care, and blood products postoperatively. However, early platelet transfusion was not associated with reinterventions, thromboembolic complications, infections, organ failure, or mortality.
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11
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Lazar HL. Preventing postoperative pneumonia: Spending a buck will save a buck. J Thorac Cardiovasc Surg 2017; 153:1392-1393. [PMID: 28238303 DOI: 10.1016/j.jtcvs.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
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Aubron C, Flint AW, Bailey M, Pilcher D, Cheng AC, Hegarty C, Martinelli A, Reade MC, Bellomo R, McQuilten Z. Is platelet transfusion associated with hospital-acquired infections in critically ill patients? Crit Care 2017; 21:2. [PMID: 28057057 PMCID: PMC5217409 DOI: 10.1186/s13054-016-1593-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/15/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Platelets are commonly transfused to critically ill patients. Reports suggest an association between platelet transfusion and infection. However, there is no large study to have determined whether platelet transfusion in critically ill patients is associated with hospital-acquired infection. METHODS We conducted a multi-centre study using prospectively maintained databases of two large academic intensive care units (ICUs) in Australia. Characteristics of patients who received platelets in ICUs between 2008 and 2014 were compared to those of patients who did not receive platelets. Association between platelet administration and infection (bacteraemia and/or bacteriuria) was modelled using multiple logistic regression and Cox regression, with blood components as time-varying covariates. A propensity covariate adjustment was also performed to verify results. RESULTS Of the 18,965 patients included, 2250 (11.9%) received platelets in ICU with a median number of 1 platelet unit (IQR 1-3) administered. Patients who received platelets were more severely ill at ICU admission (mean Acute Physiology and Chronic Health Evaluation III score 65 (SD 29) vs 52 (SD 25), p < 0.01) and had more comorbidities (31% vs 19%, p < 0.01) than patients without platelet transfusion. Invasive mechanical ventilation (87% vs 57%, p < 0.01) and renal replacement therapy (20% vs 4%, p < 0.01) were more frequently administered in patients receiving platelets than in patients without platelets. On univariate analysis, platelet transfusion was associated with hospital-acquired infection in the ICU (7.7% vs 1.4%, p < 0.01). After adjusting for confounders, including other blood components administered, patient severity, centre, year, and diagnosis category, platelet transfusions were independently associated with infection (adjusted OR 2.56 95% CI 1.98-3.31, p < 0.001). This association was also found in survival analysis with blood components as time-varying covariates (adjusted HR 1.85, 95% CI 1.41-2.41, p < 0.001) and when only bacteraemia was considered (adjusted OR 3.30, 95% CI 2.30-4.74, p <0.001). Platelet transfusions remained associated with infection after propensity covariate adjustment. CONCLUSIONS After adjustment for confounders, including patient severity and other blood components, platelet transfusion was independently associated with ICU-acquired infection. Further research aiming to better understand this association and to prevent this complication is warranted.
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Affiliation(s)
- Cécile Aubron
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,Réanimation Médicale, Centre Hospitalier et Universitaire de Brest site La Cavale Blanche - Université de Bretagne Occidentale, Bvd Tanguy Prigent, 29609, Brest Cedex, France.
| | - Andrew W Flint
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, 2160, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
| | - Allen C Cheng
- Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Colin Hegarty
- Transfusion Service, Austin Hospital, Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia
| | - Antony Martinelli
- Transfusion Service, Austin Hospital, Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia
| | - Michael C Reade
- Burns Trauma and Critical Care Research Centre, University of Queensland, Herston, Queensland, 4029, Australia.,Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, 2160, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, Austin Hospital, Melbourne, Australia
| | - Zoe McQuilten
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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13
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Ning S, Barty R, Liu Y, Heddle NM, Rochwerg B, Arnold DM. Platelet Transfusion Practices in the ICU. Chest 2016; 150:516-23. [DOI: 10.1016/j.chest.2016.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 01/04/2023] Open
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Abstract
Cardiopulmonary bypass has unpredictably deleterious effects on platelet function. Patients with cardiovascular disease have treatments aimed at reducing platelet aggregation and are at risk of excessive bleeding during surgery. Transfusion of blood products, particularly platelets, probably causes increased morbidity and mortality. Conversely, patients with excessive platelet aggregation are at risk of thrombotic complications—undesirable outcomes in the context of myocardial revascularization and prevention of stroke. Platelet function is difficult to monitor. Laboratory tests take time, and the results are not immediately available. Point-of-care (POC) testing of platelet function should facilitate the clinical management of bleeding patients by rationalizing platelet transfusion and avoiding unnecessary transfusion. Furthermore, POC platelet function could alert the clinician to risks of excessive platelet activation and measure the efficacy of antiplatelet therapy. This article outlines some of the POC platelet function monitors available as well as their potential applications.
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Affiliation(s)
- Christopher C. Harle
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada,
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15
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Engele LJ, Straat M, van Rooijen IHM, de Vooght KMK, Cremer OL, Schultz MJ, Bos LDJ, Juffermans NP. Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill. Ann Intensive Care 2016; 6:67. [PMID: 27436190 PMCID: PMC4951387 DOI: 10.1186/s13613-016-0173-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/07/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Red blood cell (RBC) transfusion has been associated with nosocomial infection in the critically ill patients. However, this association may be confounded by length of stay, as prolonged intensive care unit (ICU stay) increases both risk of infection and risk of transfusion. Also, it is not known whether specific blood products have differential risks. METHODS In this prospective multicentre cohort study, the risk of bacterial infections associated with transfusion products in critically ill (ICU) patients was determined in an integrated statistical model, using Cox proportional hazard analysis to account for attrition bias. In all acutely admitted patients with a length of stay of >48 h between 1 January 2011 and 31 December 2012, the occurrence of nosocomial infections in the ICU was prospectively monitored using CDC criteria. RESULTS Of 3502 screened patients, 476 (13.6 %) developed a nosocomial infection. These patients had higher APACHE IV scores, had longer ICU length of stay and were more frequently transfused compared to patients without an infection. Logistic regression showed that RBC transfusion was a risk factor for infection [odds ratio (OR) 1.98, 95 % confidence interval (CI) 1.54-2.55, p < 0.001], as well the number of RBC units transfused (OR 1.04, 95 % CI 1.03-1.06, p < 0.001). However, these associations disappeared in the Cox proportional hazard analysis. In contrast, we found an association between plasma transfusion and infection [hazard ratio (HR) 1.36, 95 % CI 1.10-1.69, p = 0.004] and between platelet transfusion and infection (HR 1.46, 95 % CI 1.18-1.81, p < 0.001). However, only platelet transfusion was associated with infection independently from other transfusion products (HR 1.40, 95 % CI 1.03-1.90, p = 0.03). CONCLUSIONS In critically ill patients, transfusion of platelets, but not of RBCs and plasma, is an independent risk factor for acquiring a nosocomial infection.
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Affiliation(s)
- Leo J Engele
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marleen Straat
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ingeborg H M van Rooijen
- Transfusion Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Stevens LM, Noiseux N, Prieto I, Hardy JF. Major transfusions remain frequent despite the generalized use of tranexamic acid: an audit of 3322 patients undergoing cardiac surgery. Transfusion 2016; 56:1857-65. [DOI: 10.1111/trf.13615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Louis-Mathieu Stevens
- Division of Cardiac Surgery and the; Centre Hospitalier de l'Université de Montréal (CHUM)
- Department of Anesthesiology; Centre Hospitalier de l'Université de Montréal (CHUM)
- CHUM Research Center (CRCHUM); Montréal Québec Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery and the; Centre Hospitalier de l'Université de Montréal (CHUM)
- Department of Anesthesiology; Centre Hospitalier de l'Université de Montréal (CHUM)
- CHUM Research Center (CRCHUM); Montréal Québec Canada
| | - Ignacio Prieto
- Division of Cardiac Surgery and the; Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Jean-François Hardy
- Department of Anesthesiology; Centre Hospitalier de l'Université de Montréal (CHUM)
- CHUM Research Center (CRCHUM); Montréal Québec Canada
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Ong LP, Sachdeva A, Ramesh BC, Muse H, Wallace K, Parry G, Clark SC. Lung Transplant With Cardiopulmonary Bypass: Impact of Blood Transfusion on Rejection, Function, and Late Mortality. Ann Thorac Surg 2016; 101:512-9. [DOI: 10.1016/j.athoracsur.2015.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
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18
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Kremke M, Hansen MK, Christensen S, Tang M, Andreasen JJ, Jakobsen CJ. The association between platelet transfusion and adverse outcomes after coronary artery bypass surgery. Eur J Cardiothorac Surg 2015; 48:e102-9. [DOI: 10.1093/ejcts/ezv297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/20/2015] [Indexed: 11/14/2022] Open
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Perros AJ, Christensen AM, Flower RL, Dean MM. Soluble Mediators in Platelet Concentrates Modulate Dendritic Cell Inflammatory Responses in an Experimental Model of Transfusion. J Interferon Cytokine Res 2015; 35:821-30. [PMID: 26133961 DOI: 10.1089/jir.2015.0029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The transfusion of platelet concentrates (PCs) is widely used to treat thrombocytopenia and severe trauma. Ex vivo storage of PCs is associated with a storage lesion characterized by partial platelet activation and the release of soluble mediators, such as soluble CD40 ligand (sCD40L), RANTES, and interleukin (IL)-8. An in vitro whole blood culture transfusion model was employed to assess whether mediators present in PC supernatants (PC-SNs) modulated dendritic cell (DC)-specific inflammatory responses (intracellular staining) and the overall inflammatory response (cytometric bead array). Lipopolysaccharide (LPS) was included in parallel cultures to model the impact of PC-SNs on cell responses following toll-like receptor-mediated pathogen recognition. The impact of both the PC dose (10%, 25%) and ex vivo storage period was investigated [day 2 (D2), day 5 (D5), day 7 (D7)]. PC-SNs alone had minimal impact on DC-specific inflammatory responses and the overall inflammatory response. However, in the presence of LPS, exposure to PC-SNs resulted in a significant dose-associated suppression of the production of DC IL-12, IL-6, IL-1α, tumor necrosis factor-α (TNF-α), and macrophage inflammatory protein (MIP)-1β and storage-associated suppression of the production of DC IL-10, TNF-α, and IL-8. For the overall inflammatory response, IL-6, TNF-α, MIP-1α, MIP-1β, and inflammatory protein (IP)-10 were significantly suppressed and IL-8, IL-10, and IL-1β significantly increased following exposure to PC-SNs in the presence of LPS. These data suggest that soluble mediators present in PCs significantly suppress DC function and modulate the overall inflammatory response, particularly in the presence of an infectious stimulus. Given the central role of DCs in the initiation and regulation of the immune response, these results suggest that modulation of the DC inflammatory profile is a probable mechanism contributing to transfusion-related complications.
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Affiliation(s)
- Alexis J Perros
- 1 Research and Development , Australian Red Cross Blood Service, Brisbane, Australia .,2 Faculty of Health, School of Biomedical Sciences, Queensland University of Technology , Brisbane, Australia
| | - Anne-Marie Christensen
- 1 Research and Development , Australian Red Cross Blood Service, Brisbane, Australia .,2 Faculty of Health, School of Biomedical Sciences, Queensland University of Technology , Brisbane, Australia
| | - Robert L Flower
- 1 Research and Development , Australian Red Cross Blood Service, Brisbane, Australia .,2 Faculty of Health, School of Biomedical Sciences, Queensland University of Technology , Brisbane, Australia
| | - Melinda M Dean
- 1 Research and Development , Australian Red Cross Blood Service, Brisbane, Australia .,2 Faculty of Health, School of Biomedical Sciences, Queensland University of Technology , Brisbane, Australia
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Ong LP, Thompson E, Sachdeva A, Ramesh B, Muse H, Wallace K, Parry G, Clark SC. Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality. Eur J Cardiothorac Surg 2015; 49:668-74; discussion 674. [DOI: 10.1093/ejcts/ezv155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/12/2015] [Indexed: 01/09/2023] Open
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Wu B, Wang Y, Wang C, Cheng Y, Rong R. Intraoperative platelet transfusion is associated with increased postoperative sternal wound infections among type A aortic dissection patients after total arch replacement. Transfus Med 2014; 24:400-5. [PMID: 25395085 DOI: 10.1111/tme.12162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 06/26/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- B. Wu
- Department of Transfusion; Fudan University; Shanghai China
- Department of Hematology; Fudan University; Shanghai China
| | - Y. Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai China
| | - C. Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital; Fudan University; Shanghai China
| | - Y. Cheng
- Department of Hematology; Fudan University; Shanghai China
| | - R. Rong
- Department of Transfusion; Fudan University; Shanghai China
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Shehata N, Forster A, Lawrence N, Rothwell DM, Fergusson D, Tinmouth A, Wilson K. Changing trends in blood transfusion: an analysis of 244,013 hospitalizations. Transfusion 2014; 54:2631-9. [DOI: 10.1111/trf.12644] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Nadine Shehata
- Departments of Medicine and Laboratory Medicine and Pathology; Mount Sinai Hospital; Institute of Health Policy Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Li Ka Shing Knowledge Institute; St Michael's Hospital; Toronto Ontario Canada
- Central Ontario Region; Canadian Blood Services; Toronto Ontario Canada
| | - Alan Forster
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | | | | | - Dean Fergusson
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Alan Tinmouth
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
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Transfusion practice varies widely in cardiac surgery: Results from a national registry. J Thorac Cardiovasc Surg 2013; 147:1684-1690.e1. [PMID: 24332109 DOI: 10.1016/j.jtcvs.2013.10.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 10/06/2013] [Accepted: 10/29/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Evidence is accumulating of adverse outcomes associated with transfusion of blood components. If there are differences in perioperative transfusion rates in cardiac surgery, and what hospital factors may contribute, requires further investigation. METHODS Analysis of 42,743 adult patients who underwent 43,482 procedures from 2005 to 2011 at 25 Australian hospitals, according to the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database. Multiple logistic regression examined associations of patient and hospital characteristics with transfusion of ≥1 red blood cell (RBC) unit; platelet (PLT), fresh frozen plasma (FFP), and cryoprecipitate (CRYO) doses; and ≥5 RBC units, from surgery until hospital discharge. RESULTS Procedures included 24,222 (55%) isolated coronary artery bypass grafts, 7299 (17%) isolated valve, 4714 (11%) coronary artery bypass graft and valve, and 7247 (17%) other procedures. After adjustment for various patient and procedure characteristics, transfusion rates varied across hospitals for ≥1 RBC unit from 22% to 67%, ≥5 RBC units from 5% to 25%, ≥1 PLT dose from 11% to 39%, ≥1 FFP dose from 11% to 48% and ≥1 CRYO dose from 1% to 20%. Hospital characteristics, including state or territory, private versus public, and teaching versus nonteaching, were not associated with variation in transfusion rates. CONCLUSIONS Variation in transfusion of all components and large volume RBC was identified, even after adjustment for patient and procedural factors known to influence transfusion, and this was not explained by hospital characteristics.
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Zaffar N, Joseph A, Mazer CD, Nisenbaum R, Karkouti K, Tinmouth A, Peterson MD, Pavenski K, Callum J, Cserti-Gazdewich C, Shehata N. The rationale for platelet transfusion during cardiopulmonary bypass: an observational study. Can J Anaesth 2013; 60:345-54. [DOI: 10.1007/s12630-012-9878-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022] Open
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Increased long-term mortality with plasma transfusion after coronary artery bypass surgery. Intensive Care Med 2012; 39:437-44. [PMID: 23052960 DOI: 10.1007/s00134-012-2723-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Patients undergoing cardiac surgery often require transfusions of red blood cells, plasma and platelets. These components differ widely in both indications for use and composition. However, from a statistical point of view there is a significant colinearity between the components. This study explores the relation between the transfusion of different blood components and long-term mortality. METHODS A retrospective single-centre study was performed including 5,261 coronary artery bypass grafting patients, excluding patients receiving more than eight units of red blood cells, those suffering early death (7 days) and emergency cases. Patients were followed up for a period of up to 7.5 years. A broad spectrum of potential risk factors was analysed using Cox proportional hazards survival regression. Non-significant risk factors were removed by step-wise elimination, and transfusion of red blood cells, plasma and platelets was forced to remain in the model. RESULTS The transfusion of red blood cells was not associated with decreased long-term mortality (HR = 1.007, p = 0.775), whereas the transfusion of plasma was associated with decreased long-term survival (HR = 1.060, p < 0.001), and the transfusion of platelets was associated with increased long-term survival (HR = 0.817, p = 0.011). The risk associated with transfusion of plasma was mainly attributed to patients receiving large amounts of plasma. All hazard ratios are per unit of blood product transfused. CONCLUSIONS No association was found between the transfusion of red blood cells and mortality during the study period. However, transfusion of plasma was associated with increased mortality while transfusion of platelets was associated with decreased mortality during the study period.
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Implications and management of anemia in cardiac surgery: Current state of knowledge. J Thorac Cardiovasc Surg 2012; 144:538-46. [DOI: 10.1016/j.jtcvs.2012.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 02/17/2012] [Accepted: 04/13/2012] [Indexed: 12/17/2022]
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Robinson SD, Janssen C, Fretz EB, Chase AJ, Siega AD, Carere RG, Fung A, Simkus G, Hilton JD, Berry B, Klinke WP. Non-red blood cell transfusion as a risk factor for mortality following percutaneous coronary intervention. Int J Cardiol 2012; 157:169-73. [DOI: 10.1016/j.ijcard.2010.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 10/28/2010] [Accepted: 12/04/2010] [Indexed: 01/31/2023]
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Argalious MY, Dalton JE, Mascha EJ, Cywinski JB, Clair DG. Association of red blood cell transfusion and postoperative outcomes after endovascular aortic repair. Semin Cardiothorac Vasc Anesth 2011; 15:49-55. [PMID: 21719550 DOI: 10.1177/1089253211410714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have documented worse postoperative outcomes in patients who received red blood cell (RBC) transfusion perioperatively during cardiac surgery or in critical care settings. These findings were attributed to activation of the inflammatory response with the release of cytokines and immune suppression. The aim of this study was to evaluate the association of RBC transfusion on the day of surgery and postoperative outcomes following endovascular aortic repair (EVAR). METHODS A total of 510 patients who underwent EVAR from April 2005 to March 2007 were considered for analysis. The exposure of interest was whether or not patients receive RBC transfusion on the day of surgery. The primary outcome was a composite in-hospital morbidity/mortality outcome. The authors assessed the association between RBC transfusion and our composite outcome using logistic regression after adjusting for the available potential confounders using propensity score matching. RESULTS Propensity scores were estimated for 418 out of the 510 patients; 92 patients were not included because of missing data. Propensity matching resulted in 42 successfully matched pairs. Median (quartiles) propensity score was 0.46 (0.28, 0.66) for the matched patients with transfusion and 0.46 (0.29, 0.61) for the matched patients without transfusion (P = .75, Wilcoxon rank sum test). Results of the multivariable model developed after propensity score matching suggest that RBC transfusion was not significantly associated with experiencing a postoperative complication; estimated odds ratio (95% confidence interval) of 2.7 (0.8, 9.0), P = .11. CONCLUSION In this study, RBC transfusion was not independently associated with an increased incidence of in-hospital morbidity and mortality after EVAR.
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Affiliation(s)
- Maged Y Argalious
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA.
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Bilgin YM, van de Watering LMG, Versteegh MIM, van Oers MHJ, Vamvakas EC, Brand A. Postoperative complications associated with transfusion of platelets and plasma in cardiac surgery. Transfusion 2011; 51:2603-10. [PMID: 21645007 DOI: 10.1111/j.1537-2995.2011.03200.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies in cardiac surgery have reported increased postoperative morbidity and mortality after allogeneic red blood cell (RBC) transfusions. Whether platelet (PLT) and/or plasma transfusions are a marker for more concomitant RBC transfusions or are independently associated with complications after cardiac surgery is unknown. STUDY DESIGN AND METHODS Data from two randomized controlled studies were combined to analyze the effects of PLT and/or plasma transfusions on postoperative infections, length of stay in the intensive care unit (ICU), all-cause mortality, and mortality in the presence or absence of infections in the postoperative period. RESULTS After adjusting for confounding factors, plasma units and not RBC transfusions were associated with all-cause mortality. White blood cell (WBC)-containing RBC transfusions and PLT transfusions were associated with mortality occurring in the presence of or after infections. The number of (WBC-containing) RBC transfusions was also significantly associated with postoperative infections and with ICU stay for 4 or more days. CONCLUSION Although it is difficult to separate the effects of blood components, we found that in cardiac surgery, perioperative plasma transfusions are independently associated with all-cause mortality. WBC-containing RBC transfusions and PLT transfusions are independently associated with mortality in the presence of infections in the postoperative period. Future transfusion studies in cardiac surgery should concomitantly consider the possible adverse effects of all the various transfused blood components.
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Affiliation(s)
- Yavuz M Bilgin
- Department of Immunohematology and Blood Transfusion and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Fitzmaurice GJ, Parissis HD. Platelet Transfusion Associated With Acute Lung Injury After Coronary Artery Bypass Grafting. Ann Thorac Surg 2011; 91:1977-9. [DOI: 10.1016/j.athoracsur.2010.11.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 11/18/2010] [Accepted: 11/23/2010] [Indexed: 11/29/2022]
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Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91:944-82. [PMID: 21353044 DOI: 10.1016/j.athoracsur.2010.11.078] [Citation(s) in RCA: 874] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 11/20/2010] [Accepted: 11/29/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007. METHODS The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector. RESULTS In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management. CONCLUSIONS Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations.
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Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy. Eur J Anaesthesiol 2011; 28:57-62. [DOI: 10.1097/eja.0b013e32834050ab] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McQuilten ZK, Schembri N, Polizzotto MN, Akers C, Wills M, Cole-Sinclair MF, Whitehead S, Wood EM, Phillips LE. Hospital blood bank information systems accurately reflect patient transfusion: results of a validation study. Transfusion 2010; 51:943-8. [PMID: 21077908 DOI: 10.1111/j.1537-2995.2010.02931.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hospital transfusion laboratories collect information regarding blood transfusion and some registries gather clinical outcomes data without transfusion information, providing an opportunity to integrate these two sources to explore effects of transfusion on clinical outcomes. However, the use of laboratory information system (LIS) data for this purpose has not been validated previously. STUDY DESIGN AND METHODS Validation of LIS data against individual patient records was undertaken at two major centers. Data regarding all transfusion episodes were analyzed over seven 24-hour periods. RESULTS Data regarding 596 units were captured including 399 red blood cell (RBC), 95 platelet (PLT), 72 plasma, and 30 cryoprecipitate units. They were issued to: inpatient 221 (37.1%), intensive care 109 (18.3%), outpatient 95 (15.9%), operating theater 45 (7.6%), emergency department 27 (4.5%), and unrecorded 99 (16.6%). All products recorded by LIS as issued were documented as transfused to intended patients. Median time from issue to transfusion initiation could be calculated for 535 (89.8%) components: RBCs 16 minutes (95% confidence interval [CI], 15-18 min; interquartile range [IQR], 7-30 min), PLTs 20 minutes (95% CI, 15-22 min; IQR, 10-37 min), fresh-frozen plasma 33 minutes (95% CI, 14-83 min; IQR, 11-134 min), and cryoprecipitate 3 minutes (95% CI, -10 to 42 min; IQR, -15 to 116 min). CONCLUSIONS Across a range of blood component types and destinations comparison of LIS data with clinical records demonstrated concordance. The difference between LIS timing data and patient clinical records reflects expected time to transport, check, and prepare transfusion but does not affect the validity of linkage for most research purposes. Linkage of clinical registries with LIS data can therefore provide robust information regarding individual patient transfusion. This enables analysis of joint data sets to determine the impact of transfusion on clinical outcomes.
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Affiliation(s)
- Zoe K McQuilten
- Transfusion Medicine Services, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.
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Impact of platelet count on results obtained from multiple electrode platelet aggregometry (Multiplate). Eur J Med Res 2010; 15:214-9. [PMID: 20562061 PMCID: PMC3352011 DOI: 10.1186/2047-783x-15-5-214] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Use of potent antiplatelet drugs requires evaluation of platelet function. While platelet function in elective cases is usually assessed in a central laboratory environment, there is also an urgent need for rapid perioperative point-of-care assessment. Recently, multiple electrode platelet aggregometry has been developed and assumed to measure platelet function independent from platelet count. We tested the hypothesis that results of multiple electrode platelet aggregometry are affected by platelet count, in particular if platelet count is below normal range. METHODS Whole blood samples from 20 healthy volunteers were prepared containing platelet concentrations of 50,000, 100,000, 150,000, 200,000, and 250,000 microl(-1) while maintaining hematocrit. Platelet aggregation was induced by collagen, thrombin receptor activating peptide 6 (TRAP-6), adenosine-diphoshate (ADP), and arachidonic acid, respectively, and aggregation was measured by multiple electrode platelet aggregometry (Multiplate). RESULTS Results of multiple electrode platelet aggregometry significantly decreased in blood samples with platelet count below normal range. Compared to results measured in blood samples with platelet count within normal range, aggregometry results decreased by 18.4 % (p<0.001) and 37.2 % (p<0.001) in blood samples with a platelet count of 100.000 and 50.000 microl(-1), respectively. On the other hand, large interindividual variation has been observed and some blood samples showed normal results even with platelet counts of 50.000 microl(-1). CONCLUSION The results obtained with Multiplate. Analyzer are influenced by platelet function as well as platelet count thus displaying the overall platelet aggregability within the blood sample rather than platelet function alone.
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Spiess BD. Platelet transfusions: the science behind safety, risks and appropriate applications. Best Pract Res Clin Anaesthesiol 2010; 24:65-83. [DOI: 10.1016/j.bpa.2009.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Palo R, Capraro L, Hanhela R, Koivuranta M, Nikkinen L, Salmenperä M, Salonen I, Sjövall S, Tienhaara A, Vähämurto M, Mäki T. Platelet transfusions in adult patients with particular reference to patients undergoing surgery. Transfus Med 2010; 20:30-7. [DOI: 10.1111/j.1365-3148.2009.00970.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Surgical Reexploration After Cardiac Operations: Why a Worse Outcome? Ann Thorac Surg 2008; 86:1557-62. [DOI: 10.1016/j.athoracsur.2008.07.114] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/30/2008] [Accepted: 07/31/2008] [Indexed: 11/24/2022]
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McGrath T, Koch CG, Xu M, Li L, Mihaljevic T, Figueroa P, Blackstone EH. Platelet Transfusion in Cardiac Surgery Does Not Confer Increased Risk for Adverse Morbid Outcomes. Ann Thorac Surg 2008; 86:543-53. [DOI: 10.1016/j.athoracsur.2008.04.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 04/10/2008] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
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Despotis G, Eby C, Lublin DM. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion 2008; 48:2S-30S. [PMID: 18302579 DOI: 10.1111/j.1537-2995.2007.01573.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- George Despotis
- Departments of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
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Karkouti K, Wijeysundera DN, Yau TM, McCluskey SA, van Rensburg A, Beattie WS. The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery. Transfusion 2008; 48:666-72. [DOI: 10.1111/j.1537-2995.2007.01590.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lin Y, Kanani N, Naughton F, Pendergrast J, Karkouti K. Case report: transfusion-related acute lung injury (TRALI) - a clear and present danger. Can J Anaesth 2008; 54:1011-6. [PMID: 18056211 DOI: 10.1007/bf03016636] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To describe a case of transfusion-related acute lung injury (TRALI) after platelet transfusion immediately following cardiac surgery, and to review the clinical features, pathophysiology, management, and morbidity and mortality associated with such an event. CLINICAL FEATURES A 62-yr-old man was transferred to our centre for urgent coronary artery bypass grafting in the setting of recent anti-platelet medication use. Soon after surgery he received platelet transfusions despite having only moderate blood loss. Shortly following the platelet transfusion, he suffered acute hypoxic and hypotensive decompensation requiring nitric oxide therapy, inotropic support, and prolonged need for mechanical ventilation. The patient was eventually discharged from the intensive care unit nine days following the event. The diagnosis of TRALI was made by clinical and radiographic criteria. CONCLUSION Transfusion-related acute lung injury is now the leading cause of transfusion-related fatalities. Early diagnosis of TRALI is important and these reactions should be reported to the blood transfusion service so that appropriate action can be taken to prevent future morbidity and mortality in other patients. To reduce serious transfusion reactions, inappropriate transfusions must be minimized and the decision to transfuse blood products should be taken with care.
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Affiliation(s)
- Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Body Size, Gender, and Transfusions as Determinants of Outcome After Coronary Operations. Ann Thorac Surg 2008; 85:481-6. [DOI: 10.1016/j.athoracsur.2007.10.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 09/29/2007] [Accepted: 10/02/2007] [Indexed: 11/22/2022]
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Görlinger K, Jambor C, Hanke AA, Dirkmann D, Adamzik M, Hartmann M, Rahe-Meyer N. Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis. Transfus Med Hemother 2007. [DOI: 10.1159/000109642] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Karkouti K, Wijeysundera DN, Beattie WS. Platelet transfusions as a risk factor in cardiac surgery. Transfusion 2007; 47:1739-40; author reply 1740. [PMID: 17725742 DOI: 10.1111/j.1537-2995.2007.01356.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Bruce D Spiess
- VCURES Shock Center, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0695, USA.
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Ferraris VA, Ferraris SP, Saha SP, Hessel EA, Haan CK, Royston BD, Bridges CR, Higgins RSD, Despotis G, Brown JR, Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83:S27-86. [PMID: 17462454 DOI: 10.1016/j.athoracsur.2007.02.099] [Citation(s) in RCA: 610] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 01/21/2007] [Accepted: 02/08/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes. METHODS We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme. RESULTS Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and (6) noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program that is institution based, accepted by all health care providers, and that involves well thought out transfusion algorithms to guide transfusion decisions. CONCLUSIONS Based on available evidence, institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset. Available evidence-based blood conservation techniques include (1) drugs that increase preoperative blood volume (eg, erythropoietin) or decrease postoperative bleeding (eg, antifibrinolytics), (2) devices that conserve blood (eg, intraoperative blood salvage and blood sparing interventions), (3) interventions that protect the patient's own blood from the stress of operation (eg, autologous predonation and normovolemic hemodilution), (4) consensus, institution-specific blood transfusion algorithms supplemented with point-of-care testing, and most importantly, (5) a multimodality approach to blood conservation combining all of the above.
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Johansson PI. Treatment of massively bleeding patients: introducing real-time monitoring, transfusion packages and thrombelastography (TEG®). ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-2824.2007.00084.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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