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Arun Kumar S, Prabhu S, Sanghvi A, Gogtay M, Suresh MG, Khosla H, Singh Y, Mishra AK, George S. Paradigm shift in transfusion practices during early COVID-19 pandemic: A single center retrospective study. World J Virol 2024; 13:92944. [PMID: 38984074 PMCID: PMC11229847 DOI: 10.5501/wjv.v13.i2.92944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND The advent of coronavirus disease 2019 (COVID-19) unveiled the worst national blood crisis that the United States had witnessed in over a decade. With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting, we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community. AIM To assess the adherence to restrictive blood transfusion practices for patients in the COVID era and pre-COVID era. METHODS We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital. Data was tabulated to include the number of red blood cell (RBC) transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines. Chi-square was applied to test the statistical association between qualitative variables. Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables. RESULTS A total of 208 patients were included in the study, of which 108 were during COVID era and 100 were during pre-COVID era. The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath (53.7% and 36% P = 0.001), followed by gastrointestinal bleeding (25.9% and 21% P = 0.001). There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group (38.9% vs 22%, P = 0.008). The restrictive transfusion criteria were met in 62% vs 79% in the COVID and pre-COVID eras, respectively (P = 0.008). CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.
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Affiliation(s)
- Sumukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Sushmita Prabhu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ankushi Sanghvi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Department of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Mithil Gowda Suresh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Harshit Khosla
- Hospice and Palliative Care, UTHSC and McGovern School of Medicine, Texas, TX 77030, United States
| | - Yuvaraj Singh
- Department of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, MA 01655, United States
| | - Ajay Kumar Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Susan George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Shi J, Meng M, Sa R, Yu L, Lu Y, Gao B. Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study. Clinics (Sao Paulo) 2024; 79:100379. [PMID: 38704877 PMCID: PMC11087911 DOI: 10.1016/j.clinsp.2024.100379] [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: 08/08/2023] [Revised: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND AND AIMS The association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population. METHODS The authors utilized 10 sets of 2-year cycle data (1999-2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality. RESULTS The study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust. CONCLUSIONS In the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.
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Affiliation(s)
- Jie Shi
- Department of Blood Transfusion, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China; School Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Min Meng
- Department of Medical, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Rina Sa
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Lijun Yu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yali Lu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Bei Gao
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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Zhang Y, Xu Z, Huang Y, Ye Q, Xie N, Zeng L, Lian X, Dai Y, Chen J, He P, Tan N, Liu Y. Restrictive vs. Liberal Red Blood Cell Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:736163. [PMID: 34869640 PMCID: PMC8636896 DOI: 10.3389/fcvm.2021.736163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/18/2021] [Indexed: 01/28/2023] Open
Abstract
Objective: Anemia is frequent in patients with acute myocardial infarction (AMI), and the optimal red blood cell transfusion strategy for AMI patients with anemia is still controversial. We aimed to compare the efficacy of restrictive and liberal red cell transfusion strategies in AMI patients with anemia. Methods: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, and Clinicaltrials.gov, from their inception until March 2021. Studies designed to compare the efficacy between restrictive and liberal red blood cell transfusion strategies in patients with AMI were included. The primary outcome was all-cause mortality, including overall mortality, in-hospital or follow-up mortality. Risk ratios (RR) with 95% confidence intervals (CI) were presented and pooled by random-effects models. Results: The search yielded a total of 6,630 participants in six studies. A total of 2,008 patients received restrictive red blood cell transfusion while 4,622 patients were given liberal red blood cell transfusion. No difference was found in overall mortality and follow-up mortality between restrictive and liberal transfusion groups (RR = 1.07, 95% CI = 0.82–1.40, P = 0.62; RR = 0.89, 95% CI = 0.56–1.42, P = 0.62). However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion (RR = 1.22, 95% CI = 1.00–1.50, P = 0.05). No secondary outcomes, including follow-up reinfarction, stroke, and acute heart failure, differed significantly between the two groups. In addition, subgroup analysis showed no differences in overall mortality between the two groups based on sample size and design. Conclusion: Restrictive and liberal red blood cell transfusion have a similar effect on overall mortality and follow-up mortality in AMI patients with anemia. However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion. The findings suggest that transfusion strategy should be further evaluated in future studies.
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Affiliation(s)
- Yeshen Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhengrong Xu
- Department of Cardiology, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Yuming Huang
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qirao Ye
- Department of Cardiology, Shangyou People's Hospital, Ganzhou, China
| | - Nianjin Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lihuan Zeng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xingji Lian
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, China
| | - Yining Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Cardiology, Shangyou People's Hospital, Ganzhou, China
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Schlachtenberger G, Deppe AC, Gerfer S, Choi YH, Zeriouh M, Liakopoulos O, Wahlers TCW. Major Bleeding after Surgical Revascularization with Dual Antiplatelet Therapy. Thorac Cardiovasc Surg 2020; 68:714-722. [PMID: 32593177 DOI: 10.1055/s-0040-1710508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications. METHODS Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy. RESULTS From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p < 0.0001) of mass transfusion (34 vs. 16%, p < 0.0001) and rethoracotomy (10 vs. 5%, p = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C. CONCLUSION Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery.
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Affiliation(s)
- Georg Schlachtenberger
- Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany
| | - Antje Christin Deppe
- Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Kerckhoff Vascular Centre Bad Nauheim, Bad Nauheim, Hessen, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Herz- und Thoraxchirurgie, Köln, Nordrhein-Westfalen, Germany
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Deharo P, Ducrocq G, Bode C, Cohen M, Cuisset T, Mehta SR, Pollack CV, Wiviott SD, Rao SV, Jukema JW, Erglis A, Moccetti T, Elbez Y, Steg PG. Blood transfusion and ischaemic outcomes according to anemia and bleeding in patients with non-ST-segment elevation acute coronary syndromes: Insights from the TAO randomized clinical trial. Int J Cardiol 2020; 318:7-13. [PMID: 32590084 DOI: 10.1016/j.ijcard.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/01/2020] [Accepted: 06/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The benefits and risks of blood transfusion in patients with acute myocardial infarction who are anemic or who experience bleeding are debated. We sought to study the association between blood transfusion and ischemic outcomes according to haemoglobin nadir and bleeding status in patients with NST-elevation myocardial infarction (NSTEMI). METHODS The TAO trial randomized patients with NSTEMI and coronary angiogram scheduled within 72h to heparin plus eptifibatide versus otamixaban. After exclusion of patients who underwent coronary artery bypass surgery, patients were categorized according to transfusion status considering transfusion as a time-varying covariate. The primary ischemic outcome was the composite of all-cause death or MI within 180 days of randomization. Subgroup analyses were performed according to pre-transfusion hemoglobin nadir and bleeding status. RESULTS 12,547 patients were enrolled. Among these, blood transfusion was used in 489 (3.9%) patients. Patients who received transfusion had a higher rate of death or MI (29.9% vs. 8.1%, p<0.01). This excess risk persisted after adjustment on GRACE score and nadir of hemoglobin (HR 3.36 95%CI 2.63-4.29 p<0.01). Subgroup analyses showed that blood transfusion was associated with a higher risk in patients without overt bleeding (adjusted HR 6.25 vs. 2.85; p-interaction 0.001) as well as in those with hemoglobin nadir > 9.0 g/dl (HR 4.01; p-interaction<0.0001). CONCLUSION In patients with NSTEMI, blood transfusion was associated with an overall increased risk of ischaemic events. However, this was mainly driven by patients without overt bleeding and those hemoglobin nadir > 9.0g/dl. This suggests possible harm of transfusion in those groups.
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Affiliation(s)
- P Deharo
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France
| | - G Ducrocq
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - C Bode
- Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany
| | - M Cohen
- Rutgers-New Jersey medical school, Newark, New Jersey, USA; Newark Beth Israel medical centre, Newark, New Jersey, USA
| | - T Cuisset
- Département de Cardiologie, CHU Timone, Marseille F-13385, France
| | - S R Mehta
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C V Pollack
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - S D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S V Rao
- Department of Cardiology, Duke Clinical Research Institute, Durham, NC, USA
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Netherlands Heart Institute, Utrecht, the Netherlands
| | - A Erglis
- University of Latvia, Pauls Stradins Clinical University Hospita, Riga, Latvia
| | - T Moccetti
- Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, 6900 Lugano, Switzerland
| | - Y Elbez
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - P G Steg
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France; National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK.
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Pahuja M, Ranka S, Chehab O, Mishra T, Akintoye E, Adegbala O, Yassin AS, Ando T, Thayer KL, Shah P, Kimmelstiel CD, Salehi P, Kapur NK. Incidence and clinical outcomes of bleeding complications and acute limb ischemia in STEMI and cardiogenic shock. Catheter Cardiovasc Interv 2020; 97:1129-1138. [PMID: 32473083 DOI: 10.1002/ccd.29003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Bleeding complications and acute limb ischemia (ALI) are devastating vascular complications in patients with ST-segment elevation myocardial infarction (STEMI). Cardiogenic shock (CS) can further increase this risk due to multiorgan failure. In the contemporary era, percutaneous mechanical circulatory support is commonly used for management of CS. We hypothesized that vascular complications may be an important determinant of clinical outcomes for CS due to STEMI (CS-STEMI). OBJECTIVE We evaluated 10-year national trends, resource utilization and outcomes of bleeding complications, and ALI in CS-STEMI. METHODS We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database (National Inpatient Sample) between 2005 and 2014. Events were then divided into four different groups: no MCS, with intra-aortic balloon pump, percutaneous ventricular assist device includes Impella or Tandem Heart or extracorporeal membrane oxygenation. RESULTS Bleeding complications and ALI were observed in 31,389 (18.2%) and 1,628 (0.9%) out of 172,491 admissions with CS-STEMI, respectively. Between 2005 and 2014, overall trends increased for ALI; however, the number of bleeding events decreased. ALI was associated with increased in-hospital mortality in comparison to those without any ALI. However, bleeding complications were not associated with increased in-hospital mortality. Compared to patients without complications, both bleeding and ALI were associated with increased length of stay (LOS) and hospitalization costs. CONCLUSIONS Bleeding and ALI are common complications associated with CS-STEMI in the contemporary era. Both complications are associated with increased hospital costs and LOS. These findings highlight the need to develop algorithms focused on vascular safety in CS-STEMI.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sagar Ranka
- Division of Cardiology, Department of Internal Medicine, Kansas University Medical Center, Kansas, Kansas, USA
| | - Omar Chehab
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tushar Mishra
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Emmanuel Akintoye
- Division of Cardiology, Department of Internal Medicine, University of Iowa Medical Center, Iowa, Iowa, USA
| | - Oluwole Adegbala
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ahmed S Yassin
- Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
| | - Katherine L Thayer
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Palak Shah
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, Virginia, USA
| | - Carey D Kimmelstiel
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Payam Salehi
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tuft University Medical Center, Boston, Massachusetts, USA
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Abstract
Patient blood management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of blood loss perioperatively by meticulous surgical techniques and individualized coagulation management.
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Bruno RR, Kelm M, Jung C. Spotlight on comorbidities in STEMI patients. Endocrinol Diabetes Metab 2020; 3:e00102. [PMID: 31922029 PMCID: PMC6947710 DOI: 10.1002/edm2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty University Hospital Düsseldorf Dusseldorf Germany
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Nakahashi T, Tada H, Sakata K, Yakuta Y, Tanaka Y, Gamou T, Nomura A, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Hayashi K, Yamagishi M, Kawashiri MA. Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention. J Cardiol 2019; 74:116-122. [DOI: 10.1016/j.jjcc.2019.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 01/28/2023]
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Redfors B, Watson BM, McAndrew T, Palisaitis E, Francese DP, Razavi M, Safirstein J, Mehran R, Kirtane AJ, Généreux P. Mortality, Length of Stay, and Cost Implications of Procedural Bleeding After Percutaneous Interventions Using Large-Bore Catheters. JAMA Cardiol 2019; 2:798-802. [PMID: 28315573 DOI: 10.1001/jamacardio.2017.0265] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity. Objective To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost. Design, Setting, and Participants This retrospective cohort study analyzed all 17 672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n = 3223), an endovascular aneurysm repair (n = 12 633), or a percutaneous left ventricular assist device implant (n = 1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016. Main Outcomes and Measures Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications. Results Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95% CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95% CI, 2.06-2.16; P < .001). Median (interquartile range) total health care costs were $48 663 ($32 620-$71 547) for patients with bleeding complications compared with $29 968 ($21 924-$43 287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95% CI, 1.52-1.59; P < .001). Conclusions and Relevance Periprocedural bleeding was common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.
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Affiliation(s)
- Björn Redfors
- Cardiovascular Research Foundation, New York, New York2Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Brendan M Watson
- Division of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | | | | | | | - Jordan Safirstein
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York8New York-Presbyterian Hospital/Columbia University Medical Center, New York9Associate Editor, JAMA Cardiology
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, New York6Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey10Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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Incidence and predictors of bleeding in ACS patients treated with PCI and prasugrel or ticagrelor: An analysis from the RENAMI registry. Int J Cardiol 2018; 273:29-33. [DOI: 10.1016/j.ijcard.2018.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023]
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D'Ascenzo F, Celentani D, Brustio A, Grosso A, Raposeiras-Roubín S, Abu-Assi E, Henriques JPS, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Huczek Z, Nie SP, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahayshi T, Sakata K, Yamagishi M, Kalpak O, Kedev S, Moretti C, D'Amico M, Gaita F. Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry. Am J Cardiovasc Drugs 2018; 18:299-309. [PMID: 29691803 DOI: 10.1007/s40256-018-0273-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era. METHODS AND RESULTS The BleeMACS project is a multicenter, observational, retrospective registry enrolling patients with ACS worldwide in 15 hospitals. Patients discharged with BB therapy were compared to those discharged without a BB before and after propensity score with matching. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included in-hospital reinfarction, in-hospital heart failure, 1-year myocardial infarction, 1-year bleeding and 1-year composite of death and recurrent myocardial infarction. After matching, 2935 patients for each group were enrolled. The primary endpoint of 1-year death was significantly lower in the group on BB therapy (4.5 vs 7%, p < 0.05), while only a trend was noted for recurrent acute myocardial infarction (4.5 vs 4.9%, p = 0.54). These results were consistent for patients older than 80 years of age, for ST-elevation myocardial infarction (STEMI) patients, and for those discharged with complete versus incomplete revascularization, but not for non-STEMI/unstable angina patients. CONCLUSIONS BB therapy was related to 1-year lower risk of all-cause mortality, independently from completeness of revascularization, admission diagnosis, age and ejection fraction. Randomized controlled trials for patients treated with PCI for ACS should be performed.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy.
| | - Dario Celentani
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Brustio
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Alberto Grosso
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | | | | | | | | | | | | | | | | | | | - Xiantao Song
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | - Shao-Ping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | | | | | - Dongfeng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yalei Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Neriman Osman
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | | | | | - Xiao Wang
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jing-Yao Fan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahayshi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | - Sasko Kedev
- University Clinic of Cardiology, Skopje, Macedonia
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
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Grodecki K, Huczek Z, Scisło P, Kowara M, Raposeiras-Roubín S, D'Ascenzo F, Abu-Assi E, Henriques JPS, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song XT, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Nie SP, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Scarano S, Gaita F, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Yamagishi M, Kalpak O, Kedev S, Opolski G, Filipiak KJ. Gender-related differences in post-discharge bleeding among patients with acute coronary syndrome on dual antiplatelet therapy: A BleeMACS sub-study. Thromb Res 2018; 168:156-163. [DOI: 10.1016/j.thromres.2018.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/28/2023]
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Mincu RI, Rassaf T, Totzeck M. Red blood cell transfusion in patients with ST-elevation myocardial infarction-a meta-analysis of more than 21,000 patients. Neth Heart J 2018; 26:454-460. [PMID: 30039381 PMCID: PMC6115305 DOI: 10.1007/s12471-018-1137-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Red blood cell transfusion remains controversial in patients with acute coronary syndromes and particularly in patients with ST-elevation myocardial infarction (STEMI). METHODS We systematically searched PubMed, Cochrane, EMBASE, and Web of Science for studies published until January 2017 describing the outcomes in patients with STEMI who received red blood cell transfusion, compared with patients who did not. RESULTS A total of 21,770 patients with STEMI from 5 cohort studies were included in the meta-analysis, 984 (4.5%) received red blood cell transfusion and 20,786 (95.4%) did not. Red blood cell transfusion was associated with a higher risk of in-hospital and long-term mortality, emergency repeated percutaneous coronary intervention (PCI), reinfarction rate, stroke rate, and heart failure. The group with red blood cell transfusion had a slightly higher incidence of diabetes mellitus and hypertension, but a lower incidence of smoking. The two groups had the same incidence of prior myocardial infarction, prior coronary artery bypass graft surgery and malignancy. Prior heart failure, prior stroke and prior PCI were more frequent in the group that had received red blood cell transfusion. The mean nadir haemoglobin was 8.5 ± 0.1 g/dl in the group with red blood cell transfusion and 12.5 ± 0.4 g/dl in the control group, p < 0.001. CONCLUSIONS Red blood cell transfusion increases the morbidity and mortality in patients with STEMI. This difference could not be explained by the higher morbidity in the red blood cell transfusion group alone. Further randomised controlled trials are required to provide a reliable haemoglobin threshold for these patients.
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Affiliation(s)
- R I Mincu
- Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany.,University and Emergency Hospital, Cardiac Research Unit, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - T Rassaf
- Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - M Totzeck
- Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany.
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Schoenfeld MS, Kassas I, Shah B. Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:11. [PMID: 29478085 DOI: 10.1007/s11936-018-0607-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.
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Affiliation(s)
- Matthew S Schoenfeld
- New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA
| | - Ibrahim Kassas
- New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA
| | - Binita Shah
- VA New York Harbor Healthcare System, Manhattan Campus, New York University School of Medicine, 423 E 23rd Street, Room 12023-W, New York, NY, 10010, USA.
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