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Wester ML, Sampon F, Olsthoorn JR, Soliman-Hamad MA, Houterman S, Maas AHEM, Roefs MM, Meesters MI, Ter Woorst JFJ. Gender is Independently Associated With Red Blood Cell and Platelet Transfusion in Patients Undergoing Coronary Artery Bypass Grafting: Data From the Netherlands Heart Registration. J Cardiothorac Vasc Anesth 2024; 38:924-930. [PMID: 38246823 DOI: 10.1053/j.jvca.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the incidence of transfusions, including red blood cells (RBC), platelets, and fresh frozen plasma (FFP) during and after coronary artery bypass grafting (CABG) in the Netherlands. Furthermore, the authors aimed to identify the impact of sex on blood product transfusion. DESIGN A retrospective multicenter cohort study. Data were collected from January 2013 to December 2021 from the Netherlands Heart Registration (NHR) database. SETTING The NHR receives its data from 16 heart centers in the Netherlands. PARTICIPANTS Patients older than 18 years who underwent CABG in the Netherlands. INTERVENTIONS Coronary artery bypass grafting with extracorporeal circulation or off-pump coronary artery bypass grafting. MEASUREMENTS AND MAIN RESULTS The incidence of blood transfusion, defined as transfusions intraoperatively and during the length of the hospital admission after CABG. In addition, a differentiation was made according to the type of transfusion (packed RBC, platelets, and FFP). In the overall cohort (N = 42,388), the number of patients who received a transfusion of any type was 27.0% (n = 11,428). Women received more often RBC transfusions compared with men (45.4% v 15.6%, respectively, p < 0.001). There was a significant difference between the 2 sexes regarding platelet transfusion (women 10.0% v men 11.1%, p = 0.005) but not in FFP transfusion. Female sex was independently associated with RBC transfusion, using the multivariate logistic regression analysis. CONCLUSIONS The incidence of any blood transfusion was 27.0%, and was higher in women than in men. The female sex was independently associated with receiving RBC during and after CABG.
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Affiliation(s)
- Mara-Louise Wester
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Fleur Sampon
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Mohamed A Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Netherlands Heart Registration, Utrecht, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike M Roefs
- Netherlands Heart Registration, Utrecht, the Netherlands
| | - Michael I Meesters
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Joost F J Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
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Ter Woorst J, Sjatskig J, Soliman-Hamad M, Akca F, Haanschoten M, van Straten A. Evolution of perioperative blood transfusion practice after coronary artery bypass grafting in the past two decades. J Card Surg 2020; 35:1220-1227. [PMID: 32353903 DOI: 10.1111/jocs.14573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Transfusion of blood products after coronary artery bypass grafting (CABG) is associated with increased morbidity and mortality. We evaluated the perioperative use of blood products in patients undergoing CABG in our institution over the past two decades. METHODS The study included 18 992 patients who underwent isolated CABG at our hospital between 1998 and 2017. Baseline characteristics of patients and the number of perioperative transfusions during their hospital stay (including red blood cells [RBCs], platelets, and fresh frozen plasma [FFP]) were assessed. Logistic regression models were used to identify risk factors for perioperative transfusion. RESULTS The rates of perioperative RBC transfusion decreased for all patients undergoing isolated CABG (52.1% in 1998 vs 18.6% in 2017) in our institution. The mean number of transfused RBC units was significantly higher in women than in men (1.57 ± 2.2 vs 0.68 ± 1.84; P < .005); this difference remained significant over the years. After adjusting the results for other risk factors, female sex was a significant independent risk factor for perioperative RBC transfusion. The platelet transfusion rate increased over the past two decades (1.4% in 1998 vs 9.7% in 2017). The number of FFP transfusions remained unchanged. CONCLUSIONS Over the past two decades, we observed a decrease in the incidence of perioperative RBC transfusions in patients undergoing isolated CABG, whereas platelet transfusions increased. Female sex was an independent predictor of perioperative RBC transfusion.
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Affiliation(s)
- Joost Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jelena Sjatskig
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Mohamed Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marco Haanschoten
- Department of Anaesthesiology and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Milić D, Lazarević M, Bogdanović D, Damnjanović Z, Živić S, Perić D, Kamenov A, Stojiljković V, Golubović M. DISORDERS OF COAGULATION STATUS AND HAEMOSTASIS AS PROGNOSTIC PARAMETERS OF IMMEDIATE AND EARLY RESULTS AFTER SURGICAL MYOCARDIAL REVASCULARISATION. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Arias-Morales CE, Stoicea N, Gonzalez-Zacarias AA, Slawski D, Bhandary SP, Saranteas T, Kaminiotis E, Papadimos TJ. Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective. F1000Res 2017; 6. [PMID: 28299184 PMCID: PMC5321117 DOI: 10.12688/f1000research.10085.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/29/2022] Open
Abstract
In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.
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Affiliation(s)
- Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Diana Slawski
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Sujatha P Bhandary
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Theodosios Saranteas
- Second Department of Anesthesiology, School of Medicine, University of Athens, Athens, Greece
| | - Eva Kaminiotis
- Second Department of Anesthesiology, School of Medicine, University of Athens, Athens, Greece
| | - Thomas J Papadimos
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
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Brouwers C, Hooftman B, Vonk S, Vonk A, Stooker W, Te Gussinklo WH, Wesselink RM, Wagner C, de Bruijne MC. Benchmarking the use of blood products in cardiac surgery to stimulate awareness of transfusion behaviour : Results from a four-year longitudinal study. Neth Heart J 2016; 25:207-214. [PMID: 27987079 PMCID: PMC5313448 DOI: 10.1007/s12471-016-0936-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Cardiac operations account for a large proportion of the blood transfusions given each year, leading to high costs and an increased risk to patient safety. Therefore, it is important to explore initiatives to reduce transfusion rates. This study aims to provide a benchmark for transfusion practice by inter-hospital comparison of transfusion rates, blood product use and costs related to patients undergoing coronary artery bypass grafting (CABG), valve surgery or combined CABG and valve surgery. Methods Between 2010 and 2013, patients from four Dutch hospitals undergoing CABG, valve surgery or combined CABG and valve surgery (n = 11,150) were included by means of a retrospective longitudinal study design. Results In CABG surgery the transfusion rate ranged between 43 and 54%, in valve surgery between 54 and 67%, and in combined CABG and valve surgery between 80 and 88%. With the exception of one hospital, the trend in transfusion rate showed a significant decrease over time for all procedures. Hospitals differed significantly in the units of blood products given to each patient, and in the use of specific transfused combinations of blood products, such as red blood cells (RBCs) and a combination of RBCs, fresh frozen plasma (FFP) and platelets. Conclusion This study indicates that benchmarking blood product usage stimulates awareness of transfusion behaviour, which may lead to better patient safety and lower costs. Further studies are warranted to improve awareness of transfusion behaviour and increase the standardisation of transfusion practice in cardiac surgery.
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Affiliation(s)
- C Brouwers
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
| | - B Hooftman
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - S Vonk
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - A Vonk
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - W Stooker
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - W H Te Gussinklo
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R M Wesselink
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - C Wagner
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands
| | - M C de Bruijne
- EMGO+ Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
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Liu F, Xu D, Zhang K, Zhang J. Effects of tranexamic acid on coagulation indexes of patients undergoing heart valve replacement surgery under cardiopulmonary bypass. Int J Immunopathol Pharmacol 2016; 29:753-758. [PMID: 27694613 DOI: 10.1177/0394632016671142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/01/2016] [Indexed: 12/17/2022] Open
Abstract
This study aims to explore the effects of tranexamic acid on the coagulation indexes of patients undergoing heart valve replacement surgery under the condition of cardiopulmonary bypass (CPB). One hundred patients who conformed to the inclusive criteria were selected and divided into a tranexamic acid group and a non-tranexamic acid group. They all underwent heart valve replacement surgery under CPB. Patients in the tranexamic acid group were intravenously injected with 1 g of tranexamic acid (100 mL) at the time point after anesthesia induction and before skin incision and at the time point after the neutralization of heparin. Patients in the non-tranexamic acid group were given 100 mL of normal saline at corresponding time points, respectively. Then the coagulation indexes of the two groups were analyzed. The activated blood clotting time (ACT) of the two groups was within normal scope before CPB, while four coagulation indexes including prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), and fibrinogen (FIB) had significant increases after surgery; the PT and INR of the tranexamic acid group had a remarkable decline after surgery. All the findings suggest that the application of tranexamic acid in heart valve replacement surgery under CPB can effectively reduce intraoperative and postoperative blood loss.
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Affiliation(s)
- Fei Liu
- Department of Cardiology of Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Dong Xu
- Department of Cardiology of Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kefeng Zhang
- Department of Cardiology of Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Cardiology of Xuanwu Hospital of Capital Medical University, Beijing, China
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Haanschoten MC, van Straten AHM, Soliman Hamad MA. 'Red blood transfusion in patients undergoing cardiac surgery reply'. Neth Heart J 2015; 23:346. [PMID: 25994090 PMCID: PMC4446286 DOI: 10.1007/s12471-015-0695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- M C Haanschoten
- Department of Anesthesiology, Department of Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands
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Noyez L. 'Red blood transfusion in patients undergoing cardiac surgery'. Neth Heart J 2015; 23:347. [PMID: 25894472 PMCID: PMC4446281 DOI: 10.1007/s12471-015-0696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- L Noyez
- Department of Cardio-thoracic Surgery 615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Affiliation(s)
- L Noyez
- Department of Cardio-Thoracic Surgery, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands,
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