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. 2020 Jun;34(6):1446-1456.
doi: 10.1053/j.jvca.2019.12.049. Epub 2020 Jan 7.

Intraoperative Plasma Transfusion Volumes and Outcomes in Cardiac Surgery

Mark M Smith  1 , Daryl J Kor  2 , Ryan D Frank  3 , Timothy J Weister  4 , Joseph A Dearani  5 , Matthew A Warner  2
Affiliations

Intraoperative Plasma Transfusion Volumes and Outcomes in Cardiac Surgery

Mark M Smith et al. J Cardiothorac Vasc Anesth. 2020 Jun.

Abstract

Objective: Assess outcomes after intraoperative plasma transfusion in patients undergoing cardiac surgery.

Design: Retrospective study of adult cardiac surgical between 2011 and 2015. Relationships between plasma transfusion volume, coagulation test values, and a primary outcome of early postoperative red blood cell (RBC) transfusion were assessed via multivariable regression analyses. Secondary outcomes included hospital mortality, intensive care unit and hospital-free days, intraoperative RBCs, estimated blood loss, and reoperation for bleeding.

Setting: Academic tertiary referral center.

Participants: A total of 1,794 patients received intraoperative plasma transfusions during the study period.

Interventions: None.

Measurements and main results: Higher plasma transfusion volumes were associated with worse clinical outcomes, with each 1-unit increase being associated with greater odds for postoperative RBCs [odds ratio (OR) 1.12 (confidence interval [CI] 1.04-1.20); p = 0.002], intraoperative [OR 1.85 (CI 1.69-2.03); p < 0.001], and fewer hospital-free days [mean -0.20 (-0.39, -0.01); p = 0.04]. Each 0.1 increase in pretransfusion International Normalized Ratio (INR) was associated with increased odds of postoperative and intraoperative RBCs, reoperation for bleeding, and fewer intensive care unit and hospital-free days. For given plasma volumes, patients achieving greater reduction in elevated pretransfusion INR values experienced more favorable outcomes.

Conclusions: In patients undergoing cardiac surgery who received intraoperative plasma transfusion, higher plasma transfusion volumes were associated with inferior clinical outcomes. Higher pretransfusion INR values also were associated with worse outcomes; however, those achieving a greater degree of INR correction after plasma transfusion demonstrated more favorable outcomes. Prospective studies related to plasma transfusion are needed to address this important topic.

Keywords: INR; bleeding, transfusion; cardiac surgery; coagulation; plasma.

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Figures

Figure 1.
Figure 1.
Study population flow diagram.
Figure 2.
Figure 2.
Change in INR by severity of pre-transfusion INR.
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