Red blood cell transfusion and mortality among patients hospitalized for acute coronary syndromes: A systematic review

Garfinkle, Michael; Lawler, Patrick R.; Filion, Kristian B.; Eisenberg, Mark J.

doi:10.1016/j.ijcard.2011.12.118

Cited by 34 publications

(24 citation statements)

References 21 publications

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“…Garfinkle et al . [53] also published a systematic review on 11 observational studies that enrolled 290,847 patients with acute coronary syndrome: the unadjusted OR of mortality in transfused patients ranged from 1.9 to 11.2; a meta-analysis was not performed because there was too much heterogeneity, but the data suggested a protective effect of RBC transfusion if nadir Hb drops below 80 g/L and neutral or harmful effects above 110 g/L. In summary, there is evidence in adults with cardiac disease that RBC transfusion is associated with mortality and ischemic events.…”

Section: Risks and Benefits Of Rbc Transfusionsmentioning

confidence: 99%

Anemia and red blood cell transfusion in critically ill cardiac patients

Pont‐Thibodeau

Harrington

Lacroix

2014

Ann. Intensive Care

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Anemia and red blood cell (RBC) transfusion occur frequently in hospitalized patients with cardiac disease. In this narrative review, we report the epidemiology of anemia and RBC transfusion in hospitalized adults and children (excluding premature neonates) with cardiac disease, and on the outcome of anemic and transfused cardiac patients. Both anemia and RBC transfusion are common in cardiac patients, and both are associated with mortality. RBC transfusion is the only way to rapidly treat severe anemia, but is not completely safe. In addition to hemoglobin (Hb) concentration, the determinant(s) that should drive a practitioner to prescribe a RBC transfusion to cardiac patients are currently unclear. In stable acyanotic cardiac patients, Hb level above 70 g/L in children and above 70 to 80 g/L in adults appears safe. In cyanotic children, Hb level above 90 g/L appears safe. The appropriate threshold Hb level for unstable cardiac patients and for children younger than 28 days is unknown. The optimal transfusion strategy in cardiac patients is not well characterized. The threshold at which the risk of anemia outweighs the risk of transfusion is not known. More studies are needed to determine when RBC transfusion is indicated in hospitalized patients with cardiac disease.

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Section: Risks and Benefits Of Rbc Transfusionsmentioning

confidence: 99%

Anemia and red blood cell transfusion in critically ill cardiac patients

Pont‐Thibodeau

Harrington

Lacroix

2014

Ann. Intensive Care

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“…Bleeding is a major concern of more potent P2Y 12 receptor inhibitors. Bleeding and transfusion of blood products have been associated with increased mortality in patients with ACS 7. Although there was no significant difference in the rates of major bleeding between the ticagrelor and clopidogrel groups in the overall PLATO trial, ticagrelor was associated with a higher rate of non-procedure-related major bleeding, including a higher incidence of fatal intracranial bleeding 1 8.…”

Section: Discussionmentioning

confidence: 96%

Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes

Varenhorst¹,

Alström

Braun

et al. 2014

Heart

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“…He was able to tolerate room air postextubation. recent studies have shown that blood transfusion is associated with a higher risk of mortality, independent of baseline hemoglobin level, nadir hemoglobin level, and change in hemoglobin level during the hospital stay 1,2 . american association of Blood Banks does not support use of liberal blood transfusion for hemodynamically stable patients with acute coronary syndrome (aCs) 3 .…”

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confidence: 99%

“…american association of Blood Banks does not support use of liberal blood transfusion for hemodynamically stable patients with acute coronary syndrome (aCs) 3 . while liberal blood transfusion strategy or use transfusion threshold > 11.0 g/ dl for aCs might be associated with adverse outcomes, the transfusion strategies for aCs patients with low baseline hemoglobin remain unclear [1][2][3][4][5] . In patients with acute blood loss anemia with PRBC transfusion undertaken at thresholds < 8.0 g/dl might be reasonable especially if there is reasonable clinical suspicion that acute anemia might have precipitated the acute coronary syndrome [2][3][4][5] .…”

mentioning

confidence: 99%

“…while liberal blood transfusion strategy or use transfusion threshold > 11.0 g/ dl for aCs might be associated with adverse outcomes, the transfusion strategies for aCs patients with low baseline hemoglobin remain unclear [1][2][3][4][5] . In patients with acute blood loss anemia with PRBC transfusion undertaken at thresholds < 8.0 g/dl might be reasonable especially if there is reasonable clinical suspicion that acute anemia might have precipitated the acute coronary syndrome [2][3][4][5] . however, due to lack of strong evidence american heart association/american College of Cardiology guidelines do not make firm recommendations regarding correction of anemia with packed red blood cell (prBC) transfusion in patients with aCs5.…”

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confidence: 99%

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Unnecessary Blood Transfusion in Acute Coronary Syndrome: Sometime Less is More

Sharma¹

2015

ICFJ

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we all do it, and we all know it. this is a case of an eightyyear-old gentleman with past medical history of hypertension, diabetes mellitus, hypercholesterolemia and rheumatoid arthritis, who presented to our emergency department (ed) with complaint of chest pressure beginning in the morning on the day of presentation. "I was working in the garden, and suddenly felt pressure across my chest" said the patient, describing radiation of the pain to his right shoulder and back. He mentioned sweating profusely and having some difficulty breathing. I realized that this elderly male needed further workup emergently, and an eKg was obtained in the ed -it showed st segment elevations in the inferior chest leads.at the time of admission hemoglobin level was 8.2g/dl with hematocrit of 24.6%. he was admitted to our hospital a month ago for community acquired pneumonia and his hemoglobin level during time was in range of 8-9g/dl. a year ago his primary medical doctor for this low hemoglobin worked him up and he was found to have anemia of chronic disease (high ferritin and normal transferrin with normal MCV and MChC) secondary to his past medical history of rheumatoid arthritis. during this admission serum studies confirmed an ST elevation myocardial infarction, and the patient was subsequently taken for emergent cardiac catheterization and underwent aspiration thrombectomy and right coronary artery stenting for acute right coronary artery occlusion. the following day, routine bloodwork showed hemoglobin level of 8.1g/dl with hematocrit of 24.4%; however, although he was asymptomatic and hemodynamically stable, he still received transfusion of one unit of packed red blood cells (prBC).Following the prBC transfusion, the patient unexpectedly complained of shortness of breath. he was found tachypneic with worsening blood oxygen saturation levels, requiring supplemental oxygen administration via facemask. pulmonary auscultation revealed presence of bilateral crackles and rales, more prominent at the lung bases. the intern obtained an arterial stick, and the blood gas confirmed the suspicion -hypoxemia with metabolic acidosis. the repeat cardiac enzymes were obtained, to rule out a subsequent MI, but results were negative. a bedside echocardiogram was also done to rule out cardiogenic shock (thought to be secondary to wall rupture or papillary muscle dysfunction), but the echocardiogram revealed no abnormalities. a chest X-ray was obtained which showed bilateral interstitial infiltrates with diffuse and confluent alveolar opacities on the lower two thirds of the lung fields. the diagnosis of transfusion related acute lung injury (tralI) was made and the patient required emergent intubation with administration of stress dose intravenous hydrocortisone. the patient responded to treatment and subsequently tolerated extubation within 48 hours, with chest X-ray showing clearing of bilateral lung fields. He was able to tolerate room air postextubation. recent studies have shown that blood transfusion is associated with a higher risk o...

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Red blood cell transfusion and mortality among patients hospitalized for acute coronary syndromes: A systematic review

Cited by 34 publications

References 21 publications

Anemia and red blood cell transfusion in critically ill cardiac patients

Anemia and red blood cell transfusion in critically ill cardiac patients

Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes

Unnecessary Blood Transfusion in Acute Coronary Syndrome: Sometime Less is More

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