Transfusion in Coronary Artery Bypass Grafting is Associated with Reduced Long-Term Survival

Impact of Acute Blood Loss Anemia and Red Blood Cell Transfusion on Mortality after Percutaneous Coronary Intervention

“…2 Koch demonstrated that RBC transfusion was also associated with increased mortality in the coronary artery bypass graft surgery patient. 21 Given the concern that anemia will induce cardiac ischemia and the conflicting data about the value of blood transfusion in other settings, it is not surprising that a widely accepted "transfusion threshold" does not exist after PCI. Our data suggest that 1-year mortality is not increased with nadir HCT levels as low as 24%.…”

Impaired Red Blood Cell Deformability After Transfusion of Stored Allogeneic Blood But Not Autologous Salvaged Blood in Cardiac Surgery Patients

“…31,35,39,40 The possibility that deformability of stored RBCs is impaired in a dose-dependent fashion may in part explain previous findings that the incidence of adverse outcomes is higher in patients who receive larger amounts of stored blood. 4,11,41 If the laboratory-measured changes in our study do have clinical relevance, our findings would support the use of fresh autologous salvaged blood when possible, rather than stored allogeneic blood, especially when storage duration is prolonged.…”

“…[1][2][3] Although transfusion can be lifesaving in some clinical scenarios, most observational studies have shown a clear relationship between transfusion and adverse outcomes. [4][5][6][7] In prospective clinical trials that have compared liberal to restrictive transfusion strategies, the findings have revealed either no benefit [8][9][10][11][12] or increased morbidity and mortality 13 associated with increased use of transfusions.…”

Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery

“…8 Nevertheless, the level of evidence for this concept is based on retrospective studies where the short-and even long-term outcome of patients receiving vs not receiving allogeneic transfusions is compared. 7,8,[25][26][27] Of course, the authors of these studies attempt to take into account that patients receiving allogeneic RBCs generally represent a patient population at higher risk than those not receiving transfusions and accordingly adjust for both preoperative (i.e., preoperative anemia, age, female sex, renal dysfunction, etc.) and intraoperative risk factors (i.e., urgent/emergent operations, redo surgery, complexity of surgery, and duration of CPB).…”

“…Additionally, a surgical revision is often required to control bleeding (or its sequelae-i.e., tamponade) in a variable percentage (2-7%) of patients. [2][3][4] Both perioperative bleeding and transfusions have been considered determinants of adverse outcomes, [5][6][7][8] and surgical reoperation to address bleeding is associated with an increased rate of perioperative mortality. 2,4 Therefore, bleeding and/or transfusions have been considered as specific outcome measures in many different studies.…”