Giovanni Mariscalco1, Fausto Biancari2, Tatu Juvonen2, Marco Zanobini3, Marzia Cottini4, Maciej Banach5, Gavin J Murphy6, Cesare Beghi4, Gianni D Angelini7. 1. Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy giovannimariscalco@yahoo.it. 2. Division of Cardiac Surgery and Department of Surgery, University of Oulu, Oulu, Finland. 3. Department of Cardiovascular Sciences, Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy. 4. Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy. 5. Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland. 6. Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, University of Leicester, Leicester, UK. 7. Bristol Heart Institute, University of Bristol and Imperial College of London, London, UK.
Abstract
OBJECTIVES: The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. METHODS: Data on 14 956 patients undergoing coronary artery bypass grafting (CABG) and valve surgery (with or without concomitant CABG) were retrieved at three European University Hospitals. The prognostic impact of RBC transfusion on postoperative stroke and TIA was investigated by logistic regression and multilevel propensity score analysis. RESULTS: Postoperative stroke was observed in 147 (1.0%) patients and combined stroke/TIA in 238 (1.6%). Of the total population, 6439 (43%) patients received RBC transfusion with a median of 2 units (25th-75th percentile, 2-4 units). When adjusted for other significant risk factors, RBC transfusion was an independent predictor of stroke [odds ratio (OR) 1.14; 95% confidence interval (CI) 1.11-1.17 per unit] and stroke/TIA (OR 1.12; 95% CI 1.09-1.15 per unit). Increase in the amount of transfused RBC units was associated with higher rates of stroke (no RBC transfusion: 0.5%, 1-2 RBC units: 1.0%, OR 1.42; >2 RBC units: 2.7%, OR 3.10) and stroke/TIA (no RBC transfusion: 0.8%, 1-2 RBC units: 1.8%, OR 1.49; >2 RBC units: 4.0%, OR 2.72). Multilevel propensity score analysis confirmed these findings and showed a very high risk of stroke (3.9%; OR 3.85; 95% CI 2.30-6.45) and stroke/TIA (5.9%; OR 3.30; 95% CI 2.17-5.02) associated with transfusion of ≥6 units of RBCs. CONCLUSIONS: Transfusion of more than 2 units of RBCs after cardiac surgery is associated with a significantly increased risk of postoperative stroke and TIA.
OBJECTIVES: The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. METHODS: Data on 14 956 patients undergoing coronary artery bypass grafting (CABG) and valve surgery (with or without concomitant CABG) were retrieved at three European University Hospitals. The prognostic impact of RBC transfusion on postoperative stroke and TIA was investigated by logistic regression and multilevel propensity score analysis. RESULTS: Postoperative stroke was observed in 147 (1.0%) patients and combined stroke/TIA in 238 (1.6%). Of the total population, 6439 (43%) patients received RBC transfusion with a median of 2 units (25th-75th percentile, 2-4 units). When adjusted for other significant risk factors, RBC transfusion was an independent predictor of stroke [odds ratio (OR) 1.14; 95% confidence interval (CI) 1.11-1.17 per unit] and stroke/TIA (OR 1.12; 95% CI 1.09-1.15 per unit). Increase in the amount of transfused RBC units was associated with higher rates of stroke (no RBC transfusion: 0.5%, 1-2 RBC units: 1.0%, OR 1.42; >2 RBC units: 2.7%, OR 3.10) and stroke/TIA (no RBC transfusion: 0.8%, 1-2 RBC units: 1.8%, OR 1.49; >2 RBC units: 4.0%, OR 2.72). Multilevel propensity score analysis confirmed these findings and showed a very high risk of stroke (3.9%; OR 3.85; 95% CI 2.30-6.45) and stroke/TIA (5.9%; OR 3.30; 95% CI 2.17-5.02) associated with transfusion of ≥6 units of RBCs. CONCLUSIONS: Transfusion of more than 2 units of RBCs after cardiac surgery is associated with a significantly increased risk of postoperative stroke and TIA.
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