Multivariate predictors of blood product use in cardiac surgery

Parr, K. Gage; Patel, Mrinali; Dekker, Rene; Levin, Raia; Glynn, Robert J.; Avorn, Jerry; Morse, Danielle

doi:10.1053/jcan.2003.44

Cited by 89 publications

(94 citation statements)

References 16 publications

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“…Several reports have identified risk factors for blood transfusions, 1079 -1082 including advanced age, preoperative anemia, small body size, reoperative CABG, priority of operation, duration of CPB, presence of preoperative coagulopathy, and preoperative antithrombotic therapy. 1080,[1083][1084][1085][1086][1087][1088] A multimodal approach that includes transfusion algorithms, point-of-care testing, and a focused blood conservation strategy can limit the percentage of patients requiring transfusion and the amount of blood transfusions per patient. [1052][1053][1054][1055][1056][1057] About 60% to 70% of CABG patients are taking aspirin at the time of the procedure.…”

Section: Transfusion: Recommendationmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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Section: Transfusion: Recommendationmentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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“…These included age, female gender, weight, diabetes, hypertension, repeated CABG, urgent case priority, and number of grafted vessels. 37,38 The predicted probability (propensity score) of receiving clopidogrel preoperatively for each patient was subsequently computed from the logistic regression equation. Patients who received no clopidogrel were randomly matched on the basis of the closeness of their propensity score to patients who did.…”

Section: Discussionmentioning

confidence: 99%

Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery

et al. 2006

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Background-Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach. Methods and Results-Two

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“…2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, no multivariable prediction rules have been developed that can be used by clinicians to accurately estimate the probability of MBT in cardiac surgical patients. Consequently, we sought to develop and validate such a prediction rule in a cohort of patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) at a single institution.…”

Section: Méthode : Les Données Prospectives Ont éTé Recueillies Sur Lmentioning

confidence: 99%

Prediction of massive blood transfusion in cardiac surgery

Karkouti

O’Farrell

Yau

et al. 2006

Can J Anesth/J Can Anesth

116

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Purpose:In cardiac surgery with cardiopulmonary bypass (CPB), excessive blood loss requiring the transfusion of multiple red blood cell (RBC) units is a common complication that is associated with significant morbidity and mortality. The objective of this study was to develop a prediction rule for massive blood transfusion (MBT) that could be used to optimize the management of, and research on, at-risk patients.Methods: Data were collected prospectively over the period from 2000 to 2005, on patients who underwent surgery with CPB at one hospital. Patients who received ≥ five units of RBC within one day of surgery were classified as MBT. Logistic regression was used to appropriately select and weigh perioperative variables in the prediction rule, which was developed on the initial 60% of the sample and validated on the remaining 40%.Results: Of the 10,667 patients included, 925 (8.7%) had MBT. The clinical prediction rule included 12 variables (listed in order of predictive value: CPB duration, preoperative hemoglobin concentration, body surface area, nadir CPB hematocrit, previous sternotomy, preoperative shock, preoperative platelet count, urgency of surgery, age, surgeon, deep hypothermic circulatory arrest, and type of procedure) and was highly discriminative (c-index = 0.88). In the validation set, those classified as low-, moderate-, and high-risk by a simple risk score derived from the prediction rule had a 5%, 27%, and 58% chance of MBT, respectively. Conclusion:A clinical prediction rule was developed that accurately identified patients at low-risk or high-risk for MBT. Studies are needed to determine the external generalizability and clinical utility of the prediction rule. Objectif : En cardiochirurgie avec circulation extracorporelle (CEC), une perte de sang excessive exigeant la transfusion de multiples unités de culots globulaires (CG) est une complication

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Multivariate predictors of blood product use in cardiac surgery

Cited by 89 publications

References 16 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery

Prediction of massive blood transfusion in cardiac surgery

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