Use of blood products and risk of stroke after coronary artery bypass surgery |
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Authors: | Reija Mikkola Jarmo Gunn Jouni Heikkinen Jan-Ola Wistbacka Kari Teittinen Kari Kuttila Jarmo Lahtinen Tatu Juvonen Juhani KE Airaksinen Fausto Biancari |
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Affiliation: | 1Department of Surgery, Oulu University Hospital, Oulu;;2Department of Surgery, Turku University Hospital, Turku;;3Department of Anesthesiology;4Department of Surgery, Vaasa Central Hospital, Vaasa;;5Department of Cardiology, Turku University Hospital, Turku, Finland |
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Abstract: | BackgroundThe impact of blood transfusion on the development of post-operative stroke after coronary artery bypass grafting (CABG) is not well established. We, therefore, investigated this issue.Materials and methods.Complete data on peri-operative blood transfusion were available for 2,226 patients who underwent CABG in three Finnish hospitals.ResultsStroke occurred post-operatively in 53 patients (2.4%). Logistic regression showed that pre-operative creatinine (OR 1.003, 95% CI 1.000–1.006), extracardiac arteriopathy (OR 2.344, 95% CI 1.133–4.847), pre-operative atrial fibrillation (OR 2.409, 95% CI 1.149–5.052), and the number of packed red blood cell units transfused (OR 1.121, 95% CI 1.065–1.180) were significantly associated with post-operative stroke. When the various blood product transfusions instead of transfused units were included in the multivariable analysis, solvent/detergent treated plasma (Octaplas®) transfusion (OR 2.149, 95% CI 1.141–4.047), but not red blood cell transfusion, was significantly associated with postoperative stroke. Use of blood products ranging from no transfusion (stroke rate 1.6%) to combined transfusion of red blood cells, platelets and Octaplas® was associated with a significant increase in post-operative stroke incidence (6.6%, adjusted analysis: OR 1.727, 95% 1.350–2.209). Patients who received >2 units of red blood cells, >4 units of Octaplas® units and >8 units of platelets had the highest stroke rate of 21%. CART analysis showed that increasing amount of transfused Octaplas®, platelets and history of extracardiac arteriopathy were significantly associated with post-operative stroke.ConclusionsTransfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions. |
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Keywords: | Coronary artery bypass surgery stroke blood transfusion red blood cells |
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