The Impact of Blood Component Transfusion Practices on Patient Survival After Abdominal Aortic Aneurysm Surgery

Abstract

This is an accepted version of a paper published in Vascular and Endovascular Surgery. This paper has been peer-reviewed but does not include the final publisher proofcorrections or journal pagination.

Are we cross-matching too much blood for elective open abdominal aortic aneurysm repair?

“…However, a Swedish study found there was little change in transfusion practice for open AAA repair between 1992 and 2008. 8 Long et al looked at changes in transfusion practice in America since 1980. They found that significantly less intra-operative transfusions were given in the more recent cohort (2003)(2004)(2005)(2006), with less allogenic units transfused.…”

The Clinical Implication of Blood Product Transfusion on Morbidity and Mortality of Ruptured Abdominal Aortic Aneurysm

“…However, the difference between a patient with traumatic injury and patient with rAAA needs to be considered before the administration of other blood components such as FFP and PLT. 13 In contrast to the population with trauma, the average age in vascular patient is much higher (75 vs years), and they exhibit far more comorbidities and they do not commonly present with hyoptheramia. 14 Aneurysm formation is a time-dependent process, and its morphology alters the coagulation cascade in comparison to the sudden impact of trauma on overall physiology and its immediate effect on the coagulation cascade.…”

“…However, the current literature suggests that fatal hemorrhage secondary to coagulopathy is now rare, and there has been a significant shift toward postprocedure mortality and morbidity as a consequence of thrombotic complications. 1,2 This has been attributed to the new transfusion and resuscitation techniques, where crystalloids and colloids have been replaced by blood and blood component transfusion. 3 The new transfusion (blood and blood component) protocols have evolved as a result of research surrounding patients with military and civilian trauma having catastrophic hemorrhage, where a transfusion ratio of 2:1:1 and/or 1:1:1 of packed red blood cell (PRBC) to fresh frozen plasma (FFP) to platelets (PLTs) conferred a mortality benefit.…”

“…The others included ischemic stroke (n ¼ 1), ischemic myocardial infarction (n ¼ 1), and 3 (n ¼ 3) cases of renal artery thrombosis. The median length of stay for the deceased was 14 days (interquartile range [IQR]: 8-23) as opposed to median of 8 days (IQR:[6][7][8][9][10][11][12][13][14] for patients who made it through the surgery. Their details are highlighted in…”